Outcomes of Incidental Lung Nodules With Structured Recommendations and Electronic Tracking

ObjectiveTo evaluate the impact of structured recommendations on follow-up completion for incidental lung nodules (ILNs).MethodsPatients with ILNs before and after implementation of structured Fleischner recommendations and electronic tracking were sampled randomly. The cohorts were compared for imaging follow-up. Multivariable logistic regression was used to assess appropriate follow-up and loss to follow-up, with independent variables including use of structured recommendations or tracking, age, sex, race, ethnicity, setting of the index test (inpatient, outpatient, emergency department), smoking history, and nodule features.ResultsIn all, 1,301 patients met final inclusion criteria, including 255 patients before and 1,046 patients after structured recommendations or tracking. Baseline differences were found in the pre- and postintervention groups, with smaller ILNs and younger age after implementing structured recommendations. Comparing pre- versus postintervention outcomes, 40.0% (100 of 250) versus 29.5% (309 of 1,046) of patients had no follow-up despite Fleischner indications for imaging (P = .002), and among the remaining patients, 56.6% (82 of 145) versus 75.0% (553 of 737) followed up on time (P < .001). Delayed follow-up was more frequent before intervention. Differences postintervention were mostly accounted for by nodules ≤8 mm in the outpatient setting (P < .001). In multivariable analysis, younger age, White race, outpatient setting, and larger nodule size showed significant association with appropriate follow-up completion (P < .015), but structured recommendations did not. Similar results applied for loss to follow-up.DiscussionConsistent use of structured reporting is likely key to mitigate selection bias when benchmarking rates of appropriate follow-up of ILN. Emergency department patients and inpatients are at high risk of missed or delayed follow-up despite structured recommendations.     

Management of Incidental Pituitary Findings on CT,MRI, and 18F-Fluorodeoxyglucose PET: A White Paper of the ACR Incidental Findings Committee

The ACR Incidental Findings Committee presents recommendations for managing pituitary findings that are incidentally detected on CT, MRI and ¹⁸F-fluorodeoxyglucose PET. The Pituitary Subcommittee, which included radiologists practicing neuroradiology and an endocrinologist, developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by informal iterative consensus. Algorithm branches successively categorize pituitary findings on the basis of imaging features. They terminate with an ascertainment of an indolent lesion (with sufficient confidence to discontinue follow-up) or a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. The goal is to improve the quality of care by providing guidance on how to manage incidentally detected pituitary findings.     

Incidental Findings in Radiographic Imaging for Inpatients with Acute Ischemic Stroke

Background

Incidental findings on radiographic diagnostic imaging are a growing concern in the medical field. Little is known about the incidence and spectrum of incidental findings uncovered during stroke evaluations.

Is it Necessary to Submit Grossly Normal Looking Gall Bladder Specimens for Histopathological Examination?

Background: The objectives of the study were to: 1) determine the frequency of incidental malignancy inunsuspected/grossly normal looking gall bladders; 2) determine the frequency of malignancy in suspected/grosslyabnormal looking gall bladders. Materials and Methods: This prospective, cross sectional study was carried outat a tertiary care hospital in Pakistan, during a four year period (Jan 2009-dec2012). All the cholecystectomycases performed for gallstone diseases were examined initially by a surgeon and later on by a pathologist formacroscopic abnormalities and accordingly assigned to one of the three categories i.e. grossly normal, suspicious,abnormal/malignant. Frequency of incidental carcinoma in these categories was observed after receiving the finalhistopathology report. Results: A total of 426 patients underwent cholecystectomy for cholelithiasis, with a 1:4male: female ratio. Mean age of the patients was 45 years with a range of 17-80 years. The frequency of incidentalgallbladder carcinoma was found to be 0.70 %(n=3). All the cases of gallbladder carcinoma were associatedwith some macroscopic abnormality. Not a single case of incidental carcinoma gallbladder was diagnosed in383 ‘macroscopically normal looking’ gallbladders. Conclusions: Incidental finding of gall bladder cancer wasnot observed in any of macroscopically normal looking gall bladders and all the cases reported as carcinomagallbladder had some gross abnormality that made them suspicious. We suggest histopathologic examinationof only those gall bladders with some gross abnormality.     

Subjects' expectations in neuroimaging research

PURPOSE: To explore subjects' attitudes and expectations concerning the detection and management of incidental findings in neuroimaging research. MATERIALS AND METHODS: Healthy control subjects (N = 105) who previously participated in neuroimaging studies in medical and nonmedical settings were surveyed about their expectations and attitudes toward unexpected clinical findings on their research brain scans. We hypothesized that even though the participants consented to a scanning procedure for research purposes alone, they would still expect pathology, if present, to be detected and reported to them. RESULTS: Fifty-four percent of participants reported that they expected research scans to detect abnormalities if they existed. Nearly all subjects (>90%) reported that they would want findings communicated to them, and many (59%) preferred this to be done by a physician affiliated with the research team. The participants responded in similar ways whether they were scanned in medical or nonmedical settings. CONCLUSION: Clarity about procedures for handling incidental findings when obtaining written and verbal informed consent is essential to ensure that the subjects' expectations are consistent with the purpose and scope of the research.