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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Relevant incidental findings at abdominal multi-detector contrast-enhanced computed tomography: A collateral screening?
Luca Maria Sconfienza, Giovanni Mauri, Claudia Muzzupappa, Alessandro Poloni, Michele Bandirali, Anastassia Esseridou, Stefania Tritella, Francesco Secchi, Giovanni Di Leo, Francesco Sardanelli
Luca Maria Sconfienza, Giovanni Mauri, Michele Bandirali, Anastassia Esseridou, Stefania Tritella, Francesco Secchi, Giovanni Di Leo, Francesco Sardanelli, Servizio di Radiologia, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Milano, Italy
Luca Maria Sconfienza, Francesco Secchi, Francesco Sardanelli, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20097 San Donato Milanese, Milano, Italy
Claudia Muzzupappa, Alessandro Poloni, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122 Milano, Italy
Author contributions: Sconfienza LM, Mauri G, Di Leo G and Sardanelli F contributed to research pianification; Mauri G, Di Leo G and Sardanelli F contributed to statistical analysis; all authors contributed to data analysis, manuscript drafting and final approval.
Institutional review board statement: Institutional Review Board approval of IRCCS Ospedale San Raffaele, Milano, Italy was obtained.
Informed consent statement: Patients’ informed consent was waived.
Conflict-of-interest statement: Authors have no conflict of interest to disclose related to the present paper.
Data sharing statement: Dataset is available from the corresponding author according to what is foreseen by the IRB.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luca Maria Sconfienza, MD, PhD, Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milano, Italy. io@lucasconfienza.it
Telephone: +39-02-52774468 Fax: +39-02-52774925
Received: May 16, 2015
Peer-review started: May 20, 2015
First decision: July 10, 2015
Revised: July 31, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: October 28, 2015
AIM: To investigate the prevalence of relevant incidental findings (RIFs) detected during routine abdominal contrast-enhanced computed tomography (CeCT).
METHODS: We retrospectively evaluated the reports of a consecutive series of abdominal CeCT studies performed between January and May 2013. For each report, patients’ age and sex, admission as inpatient or outpatient, clinical suspicion as indicated by the requesting physician, availability of a previous abdominal examination, and name of the reporting radiologist were recorded. Based on the clinical suspicion, the presence and features of any RIFs (if needing additional workup) was noted.
RESULTS: One thousand forty abdominal CeCT were performed in 949 patients (528 males, mean age 66 ± 14 years). No significant difference was found between inpatients and outpatients age and sex distribution (P > 0.472). RIFs were found in 195/1040 (18.8%) CeCT [inpatients = 108/470 (23.0%); outpatients = 87/570 (15.2%); P = 0.002]. RIFs were found in 30/440 (6.8%) CeCT with a previous exam and in 165/600 (27.5%) without a previous exam (P < 0.001). Radiologists’ distribution between inpatients or outpatients was significantly different (P < 0.001). RIFs prevalence increased with aging, except for a peak in 40-49 year group. Most involved organs were kidneys, gallbladder, and lungs.
CONCLUSION: A RIF is detected in 1/5 patients undergoing abdominal CeCT. Risk of overdiagnosis should be taken into account.
Core tip: A relevant incidental finding (IF) is detected in one out of five patients undergoing abdominal contrast-enhanced computed tomography. Thus, in clinical practice, we daily perform unconscious collateral screening for a number of abdominal diseases. Notably, a problem still exists about how to deal with these findings, as their detection can be stressful and potentially harmful for patients, also contribute to increase in health care costs. On the one hand we have the risk of overdiagnosis, on the other hand there is a risk of legal issues for not having reported and suggested further work-up for these IFs.
