Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Incidental findings are common with chest CT and MRI of the spine and brain
Clinical Question
What is the likelihood and outcomes of incidental findings on imaging tests?
Bottom line
The risks of imaging, in addition to radiation exposure, also include the identification of "Incidentalomas," which can lead to patient anxiety, further testing, and overtreatment, and there is little research to guide what to do when they pop up on an imaging report (as the famous dodge "clinical correlation needed"). Computerized tomography (CT) of the chest (45%), CT colonoscopy (38%), and cardia magnetic resonance imaging (34%) commonly produce incidental findings. The rate of malignancy in incidentalomas was high in breast (42%) and ovary (28%) fidnings; intermediate in prostatic and colonic (10% - 20%) findings; and low in brain, parotid, and adrenal gland (< 5%) findings. Although everyone has a story of the lifesaving results of such serendipity, we don't often consider the patients subjected to unneeded testing and treatment, the so-called Victims Of Modern Imaging Technology—you can figure out the acronym (BMJ 2003;326:1273). 2a
Reference
Study design: Systematic review
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
These authors searched 2 databases and reference lists of included papers to identify 20 systematic reviews of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas") in patients already being imaged for cancer. Incidentalomas were defined differently across the systematic reviews. CT of the chest resulted in incidentalomas reported in 45% of patients (95% CI 36% - 55%). The relatively new CT colonoscopy resulted in incidental findings in 38% of patients (21% - 57%). Magnetic resonance imaging also reported incidental findings when imaging the spine (22%) and brain (22%). Whole body positron emission tomography (PET) and PET/computed tomography had rates of 2% (95% CI 1% to 4%). No studies have determined the prevalence of incidentalomas identified via radiography or ultrasound. Malignancy of incidentalomas were highest with breast findings (42%; 31% - 54%). Renal, thyroid, and ovarian findings were malignant approximately 25% of the time. Extra-colonic, prostatic, and colonic incidentalomas were malignant 10% to 20% of the time. Rates of incidentalomas varied substantially among the meta-analyses.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
The lack of practical clinical knowledge of the statistician who provides this POEM is frequently disappointing as it is again with the unintelligent comment made in this case "(as the famous dodge "clinical correlation needed")". The paper accurately identifies that incidental findings are commonly discovered in these exams. Clinical correlation, with the patient's physical findings and bloodwork and symptoms and past imaging and surgical history is required to decide what further follow-up is indicated. The poorly labelled "dodge" is a responsible suggestion towards resolution of the dilemma. It does involve further clincal thought and judgement and perhaps investigation depending on the nature of the incidentaloma discovered.
From this poem it appears even VOMIT is subjected to iatrogenic suffering!
Good poem
Thanks to the authors For quantifying the risk of v.o.m.i.t. To patients undergoing these vital investigations
still unanswered the outcome of all negative findings on followup investigations and patient outcome(s) including the advert effects of radiation mid and long term
This is an *excellent* study - what is needed is a comment on - "is it worth it" or not?
who writes these summaries?
Very interesting. I would say though referring to a 42% chance of malignancy in the finding of a breast incidentaloma is a misnomer. It is a highly important finding that clearly requires further investigation. Even if the subsequent investigations turn out to be "negative" I would not say the patient was a victim of modern imaging technology.