Radiologists recommend appropriate incidental findings follow-up often, not always

Over the course of one month, radiologists reading CT scans of the abdomen and pelvis recommended appropriate follow-up for incidental findings (IFs) over 90% of the time, failing primarily when the IF was an aneurysm, according to findings made available by Steven Boe, MD, and colleagues at the American College of Radiology’s ACR 2015 Annual Meeting.

The authors reviewed 561 CT scan reports of the abdomen and pelvis performed in December 2014 at Hartford Hospital in Hartford, Conn., looking at each report to see if any IFs were present. They studied each  IF—317 in total—to see if the reading radiologist followed ACR guidance.

Overall, IF follow-up was managed appropriately 90.5% of the time. The authors said that a majority of the inappropriate management included a lack of recommended follow-up for aneurysms, adrenal nodules and adnexal cysts. In addition, proper follow-up was not advised for a complex renal cyst and a renal mass. Unnecessary follow-up studies were recommended for 2 adrenal nodules, 2 premenopausal cysts, and a pancreatic cyst.

The data tells a different story than what the authors expected.

“We did not expect the majority of the inappropriately managed IFs to include lack of recommended follow up,” Boe told via e-mail. “We hypothesized that the majority would be comprised of unnecessary follow up studies recommended for benign IFs.”

Radiologists struggled the most with recommending follow-up when the IF in question was an aneurysm. Of the aneurysms identified as IFs, almost 74% were inappropriately managed. The other noticeable issue was adnexal cysts, which were inappropriately managed over 21% of the time. The most commonly identified IF, renal cysts, were managed appropriately 99.3% of the time.

The authors suggest increased awareness of ACR guidance related to IFs. Boe said he presented these findings to the physicians at Hartford Hospital, and will likely conduct a follow-up study there.

He also said he sees a place for other similar studies to be conducted in the future.

“There is definitely room for expansion on this topic,” Boe said. “For example, retrospective review of CT and MRI scans of the neck and chest could be reviewed for appropriateness of management for thyroid nodules.”