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European Respiratory Review : An... Jun 2022The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity... (Review)
Review
The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity defined as the incidental finding of computed tomography (CT) abnormalities affecting more than 5% of any lung zone. Two recent documents have redefined the borders of this entity and made the recommendation to monitor patients with ILA at risk of progression. In this narrative review, we will focus on some of the limits of the current approach, underlying the potential for progression to full-blown ILD of some patients with ILA and the numerous links between subpleural fibrotic ILA and idiopathic pulmonary fibrosis (IPF). Considering the large prevalence of ILA in the general population (7%), restricting monitoring only to cases considered at risk of progression appears a reasonable approach. However, this suggestion should not prevent pulmonary physicians from pursuing an early diagnosis of ILD and timely treatment where appropriate. In cases of suspected ILD, whether found incidentally or not, the pulmonary physician is still required to make a correct ILD diagnosis according to current guidelines, and eventually treat the patient accordingly.
Topics: Disease Progression; Humans; Idiopathic Pulmonary Fibrosis; Incidental Findings; Lung; Lung Diseases, Interstitial; Tomography, X-Ray Computed
PubMed: 35418487
DOI: 10.1183/16000617.0206-2021 -
Indian Journal of Dental Research :... 2009Rhinoliths are rare entities encountered in clinical practice. They are calcified masses found within the nasal cavity. Which lesions can be encountered incidentally...
Rhinoliths are rare entities encountered in clinical practice. They are calcified masses found within the nasal cavity. Which lesions can be encountered incidentally upon a routine dental radiograph. This article reports a case of such an incidental finding of rhinolith on a dental radiograph.
Topics: Adult; Humans; Incidental Findings; Lithiasis; Male; Nasal Cavity; Nose Diseases; Radiography
PubMed: 19336872
DOI: 10.4103/0970-9290.49062 -
Archives of Pathology & Laboratory... Jan 2022Next-generation sequencing is a powerful clinical tool for cancer management but can produce incidental/secondary findings that require special consideration. (Review)
Review
CONTEXT.—
Next-generation sequencing is a powerful clinical tool for cancer management but can produce incidental/secondary findings that require special consideration.
OBJECTIVE.—
To discuss clinical and laboratory issues related to incidental or secondary germline findings in the clinical setting of tumor testing and inform future guidelines in this area.
DESIGN.—
A College of American Pathologists workgroup including representation from the American Society of Clinical Oncology, the Association for Molecular Pathology, and the American College of Medical Genetics and Genomics created a review of items that should be considered when developing guidelines for incidental or secondary findings when performing clinical tumor testing.
RESULTS.—
Testing recommendations should be cognizant of the differences among anticipated incidental, unanticipated incidental, and secondary findings, and whether normal tissue is also tested. In addition to defining which variants will be reported, robust recommendations must also take into account test design and validation, reimbursement, cost, infrastructure, impact on reflex testing, and maintenance of proficiency. Care providers need to consider the potential of a test to uncover incidental or secondary findings, the recommendation of upfront counseling, the need for consent, the timing of testing and counseling, and that the exact significance of a finding may not be clear.
CONCLUSIONS.—
As clinical oncology testing panels have become a mainstay of clinical cancer care, guidelines addressing the unique aspects of incidental and secondary findings in oncology testing are needed. This paper highlights clinical and laboratory considerations with regard to incidental/secondary findings and is a clarion call to create recommendations.
Topics: Genetic Testing; Germ Cells; High-Throughput Nucleotide Sequencing; Humans; Incidental Findings; Laboratories; Medical Oncology; Neoplasms
PubMed: 33769456
DOI: 10.5858/arpa.2020-0025-CP -
Medicina 2023
Topics: Humans; Osteopoikilosis; Incidental Findings; Radiography
PubMed: 38117729
DOI: No ID Found -
Asian Journal of Surgery May 2022
Topics: Choriocarcinoma; Female; Humans; Incidental Findings; Pregnancy
PubMed: 35241327
DOI: 10.1016/j.asjsur.2022.01.110 -
Clinical Imaging 2016Advanced imaging technologies play a central role in screening asymptomatic patients. However, the balance between imaging-based screening's potential benefits versus... (Review)
Review
Advanced imaging technologies play a central role in screening asymptomatic patients. However, the balance between imaging-based screening's potential benefits versus risks is sometimes unclear. Radiologists will have to address ongoing concerns, including high false-positive rates, incidental findings outside the organ of interest, overdiagnosis, and potential risks from radiation exposure. In this article, we provide a brief overview of these recurring controversies and suggest the following as areas that radiologists should focus on in order to tip the balance toward more benefits and less harms for patients undergoing imaging-based screening: interpretive variability, abnormal finding thresholds, and personalized, risk-based screening.
Topics: Diagnostic Errors; Diagnostic Imaging; Early Detection of Cancer; Humans; Incidental Findings; Neoplasms
PubMed: 26112898
DOI: 10.1016/j.clinimag.2015.06.003 -
The European Respiratory Journal Jun 2017Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of... (Review)
Review
Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of oncological CT scans. Despite this high frequency, optimal management of incidental PE has not been addressed in clinical trials and remains the subject of debate. Although these CT scans have not been performed with a dedicated PE protocol and have suboptimal contrast enhancement, diagnosis of incidental PE has been shown to be accurate up to the segmental and subsegmental arteries. The embolic load in incidental PE is lower than that in symptomatic PE. Even so, observational studies suggest that the natural course of incidental PE is similar to that of symptomatic PE with regard to the risk of recurrent venous thrombotic disease and mortality. Interestingly, the increased use of more advanced CT technology has coincided with an increase in the rate of incidental subsegmental PE, as is the case for symptomatic subsegmental PE. Although clinical trials are lacking, and observational data are limited to cancer-associated incidental PE, the consensus is that the management of incidental PE is identical to that of symptomatic PE, including the choice of optimal drug class, outpatient treatment and total duration of treatment.
Topics: Anticoagulants; Disease Management; Female; Humans; Incidental Findings; Middle Aged; Neoplasms; Practice Guidelines as Topic; Pulmonary Embolism; Tomography, X-Ray Computed
PubMed: 28663318
DOI: 10.1183/13993003.00275-2017 -
Cleveland Clinic Journal of Medicine Mar 2021
Topics: Celiac Artery; Constriction, Pathologic; Humans; Incidental Findings; Median Arcuate Ligament Syndrome
PubMed: 33648962
DOI: 10.3949/ccjm.88a.20052 -
BMJ (Clinical Research Ed.) Jun 2018To provide an overview of the evidence on prevalence and outcomes of incidental imaging findings. (Review)
Review
OBJECTIVE
To provide an overview of the evidence on prevalence and outcomes of incidental imaging findings.
DESIGN
Umbrella review of systematic reviews.
DATA SOURCES
Searches of MEDLINE, EMBASE up to August 2017; screening of references in included papers.
ELIGIBILITY CRITERIA
Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses.
RESULTS
20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extra-colonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 meta-analyses with I >50%).
CONCLUSIONS
There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO: CRD42017075679.
Topics: Diagnostic Imaging; Humans; Incidental Findings; Prevalence; Treatment Outcome
PubMed: 29914908
DOI: 10.1136/bmj.k2387 -
Einstein (Sao Paulo, Brazil) 2017An asymptomatic 79-year-old woman, with incidental finding on abdominal ultrasound of a solid nodule in the tail of the pancreas. Magnetic resonance imaging showed a...
An asymptomatic 79-year-old woman, with incidental finding on abdominal ultrasound of a solid nodule in the tail of the pancreas. Magnetic resonance imaging showed a 12mm solid tumor. The suggested diagnosis was pancreatic neuroendocrine tumor. The pathological examination showed an intrapancreatic splenic tissue. This is a rare ectopic location of spleen tissue and it should be considered in the differential diagnosis of pancreatic solid tumors.
Topics: Aged; Choristoma; Diagnosis, Differential; Female; Humans; Incidental Findings; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreatic Diseases; Spleen
PubMed: 28614428
DOI: 10.1590/S1679-45082017RC3942