Incidental findings: A retrospective analysis of management

Incidental findings: A retrospective analysis of management

Authors and disclosures Authors: Steven Boe, Dana Boe, Jeffrey Kaye, Anu Bansal, Marc Glickstein Disclosures: None

Purpose Determine if appropriate follow-up is being recommended for incidental findings (IFs) detected on CT scans of the abdomen and pelvis

Background IFs are discovered on imaging studies performed for unrelated indications Aggressive management of IFs can lead to patient anxiety, increased radiation exposure, increased cost, and unnecessary procedures with potentially injurious outcomes

Background The American College of Radiology (ACR) has published several White Papers through the Incidental Findings Committees Committees were composed of experts in various organ systems Consensus agreements on management of IFs were reached based on available literature and personal experience

Methods and materials Retrospective chart review: 561 CT scan reports of the abdomen and pelvis performed at a tertiary medical center Scans with IFs were studied to determine if recommendations provided by the reading radiologist followed guidance provided by the ACR Incidental Findings Committees

Methods and Materials Organs included: kidneys, pancreas, spleen, adrenal glands, adnexa, gallbladder, biliary tract, vascular and nodal IFs excluded: hepatic cysts and masses Excluded due to difficulty in risk stratification and limited characterization with single phase CT If multiple IFs were found in one report, each IF was included due to separate and distinct recommendations Images were evaluated for clarification of findings as needed Institutional review board approval was obtained with waiver of consent

Results 317 IFs identified: 83.6% ED, 13.9% inpatient, and 2.5% outpatient Appropriate management for 90.5% Majority of remaining 9.5% included lack of recommended follow up for aneurysms, adrenal nodules, and adnexal cysts in postmenopausal women Proper follow-up not advised for a complex renal cyst and a renal mass Unnecessary follow-up studies recommended for 2 adrenal nodules, 2 premenopausal cysts, and 1 pancreatic cyst

Results Table 1. IFs identified along with appropriateness of management. Total Appropriately managed Inappropriately managed Renal cysts 147, 46.4 146, 99.3 1, 0.7 Cholecystic 42, 13.2 42, 100 0, 0 Adnexal cysts 33, 10.4 26, 78.8 7, 21.2 Adrenal nodules 24, 7.6 18, 75 6, 25 Aneurysms 19, 6 5, 26.3 14, 73.7 Biliary 17, 5.4 17, 100 0, 0 Nodal 16, 5 16, 100 0, 0 Pancreatic cysts 5, 1.6 4, 80 1, 20 Splenic cysts 5, 1.6 5, 100 0, 0 Venous findings 4, 1.3 4, 100 0, 0 Renal masses 3, 0.9 2, 66.7 1, 33.3 Pancreatic masses 1, 0.3 1, 100 0, 0 Splenic masses 1, 0.3 1, 100 0, 0 Reported as number, percentage

Conclusion Majority of inappropriate management included lack of recommended follow up for aneurysms, adrenal nodules, and adnexal cysts in postmenopausal women. Increased awareness of management guidelines available for IFs may improve long-term patient outcomes and minimize unnecessary follow up.

References 1. Berland L, Silverman S, Gore R, et al. Managing incidental findings on abdominal CT: white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2010; 7: 754-773. 2. Shuaib W, Johnson J, Salastekar N, et al. Incidental findings detected on abdomino-pelvic multidetector computed tomography performed in the acute setting. Am J Emerg Med. Jan 2014; 32(1): 36-9. 3. Booth T, Waldman A, Wardlaw J, et al. Management of incidental findings during imaging research in healthy volunteers: current UK practice. Br J Radiol. Jan 2012; 85(1009): 11-21. 4. Berland L. Overview of white papers of the ACR Incidental Findings Committee II on adnexal, vascular, splenic, nodal, gallbladder, and biliary findings. J Am Coll Radiol. 2013; 10: 672-674. 5. Patel M, Ascher S, Paspulati R, et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol. 2013; 10: 675-681. 6. Khosa F, Krinsky G, Macari M, et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 2: white paper of the ACR Incidental Findings Committee II on vascular findings. J Am Coll Radiol. 2013; 10: 789-794. 7. Heller M, Harisinghani M, Neitlich J, et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR Incidental Findings Committee II on splenic and nodal findings. J Am Coll Radiol. 2013; 10: 833-839. 8. Sebastian S, Araujo C, Neitlich J, et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol. 2013; 10: 953-956.