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Incidental findings prevalence varied by imaging modality and other factors
Orme N. Arch Intern Med. 2010;170:1525-1532.
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New study data appearing in the Archives of Internal Medicine has indicated that the frequency of incidental findings varies significantly as a result of imaging modality, body region and age.
In this study, researchers analyzed medical records of patients undergoing a research imaging examination from January to March 2004 and whose results were interpreted by a radiologist. They estimated the frequency of incidental findings that generated further clinical action by modality, age, sex and body part, along with net medical benefit or burden.
During the 3-year follow-up, 567 of the 1,426 research imaging examinations (39.8%) had at least one incidental finding. Age significantly increased the risk of an incidental finding (per decade increase, OR=1.5; 95% CI, 1.4-1.7). Abdominopelvic CT (OR=18.9; 95% CI, 9.3-38.5) generated more incidental findings than thorax (OR=11.9; 95% CI, 6.1-23.3) and all other examinations (OR=5.8; 95% CI, 2.3-15.1) compared with ultrasonography. Additionally, MRIs of the head (OR=5.9; 95% CI, 2.9-11.7) and all other body parts (OR=3.0; 95% CI, 1.3-6.9) produced notably higher incidental findings than ultrasonography.
"This study demonstrates that research imaging incidental findings are common in certain types of imaging examinations, potentially offering an early opportunity to diagnose asymptomatic life-threatening disease, as well as a potential invitation to invasive, costly and, ultimately, unnecessary interventions for benign processes,"� the researchers commented in their study. "Timely, routine evaluation of research images by radiologists can result in identification of incidental findings in a substantial number of cases that can result in significant medical benefit to a small number of patients."�
Bernard Lo, MD, with the program of medical ethics, University of California, San Francisco, wrote in an accompanying editorial that although incidental findings are common in research, researchers must develop a comprehensive plan for how they will respond to them, "including what findings they will offer to disclose to participants,"� he said. "The possibility of incidental findings, and their ramifications, should be part of the informed-consent process. The work by Orme et al helps us start to quantify their impact."�
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