A Patient’s Viewpoint on a Current Controversy

Casarella, William J.

doi:10.1148/radiol.2243020024

Cited by 58 publications

(31 citation statements)

References 4 publications

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“…For example, the pursuit of false-positive CT findings in lungs is at best costly, anxiety producing and involves 2 years of repeated CT scans. At worst, it will lead to painful, costly and potentially risky major surgical procedures [19].…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of the use of additional ultrasonography in diagnostic breast imaging

et al. 2008

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The degree of adherence with evidence-based guidelines for the use of breast ultrasonography was determined in clinical practice of radiologists in six hospitals. Additional ultrasonography was performed in 2,272 (53%) of all 4,257 patients referred for mammography. High adherence rates (mean: 95%) were observed for guidelines recommending ultrasonography in patients referred for palpable breast masses and abnormal screening and diagnostic mammograms. Lower adherence rates (mean: 81%, Pearson correlation coefficient=−0.57; p=0.001) were found for guidelines advising against additional ultrasonography in patients referred for breast symptoms, a known benign abnormality, a family history or anxiety of breast cancer. The overuse of ultrasonography in 442 patients and underuse in 95 patients led to five additional false-positive results. It was concluded that the guidelines seem workable and feasible in clinical practice and that the current daily routine of diagnostic breast imaging corresponded to a great extent to the guidelines proposed.

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Section: Discussionmentioning

confidence: 99%

Clinical impact of the use of additional ultrasonography in diagnostic breast imaging

et al. 2008

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“…Imagers are obliged to report any potentially significant findings observed, whether related to potential lung cancer or not. These additional observations may themselves incur downstream diagnostic tests that involve additional risk and potential death (40). Studies that follow and report medical outcomes on only the small percentage of individuals with suspected or diagnosed lung cancer cannot inform the benefits or risks of CT screening across the entire population being screened.…”

Section: Survival Versus Mortality Endpoints In Screeningmentioning

confidence: 99%

Lung Cancer Screening with CT

Aberle

Brown

2008

Clinics in Chest Medicine

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Lung cancer is the leading cause of cancer death in the United States. In 2007, it is estimated that 160,390 lung cancer deaths will occur in the US, representing 29% of all cancer deaths (1). Roughly 87% of lung cancers are attributed to cigarette smoking (2). Although cancer risk is attenuated by smoking cessation, the risk is not eliminated, and lung cancer now occurs with equal frequency in current and former smokers (3). Moreover, other factors clearly influence risk, including age; family history; chronic obstructive pulmonary disease; pulmonary fibrosis; and exposures to environmental radon, asbestos, and certain other occupational agents (4). Realistically, lung cancer will likely remain at epidemic proportions for decades to come.Non-small cell lung cancer (NSCLC), which accounts for 75-80% of all lung cancers, is typically diagnosed when disease is locally advanced or there are systemic metastases (5), explaining the dismal overall five-year survival of 15% (6). In contrast, the five-year survival of individuals with surgically resected, early stage NSCLC approaches 75% (6,7). These differences have fueled the impetus to find a screening test that can detect NSCLC in its early preclinical stages, when surgical resection is most likely to prolong life and potentially reduce lung cancer mortality. Although earlier randomized controlled trials of lung cancer screening using chest radiography and sputum cytology failed to show reduced lung cancer mortality, computed tomography (CT) is a much more sensitive test for detecting small lung nodules, and has generated considerable enthusiasm as a potential contemporary screening tool for lung cancer.

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“…Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs.…”

mentioning

confidence: 99%

“…Apart from such benefi ts as earlier diagnosis and treatment or prevention, 8,22 there are several negative consequences that should be considered: radiation exposure, iatrogenic illness, patient inconvenience from additional testing, potentially unnecessary costs, and the psychological burden of false-positive results, as well as the detection of untreatable disease or diseases that might never have become symptomatic during life (overdiagnosis). 10,11 Finally, patients volunteering to participate in an observational study may differ from the general population in primary care with acute cough. We did not gather data on eligible patients who were not included in the study and assume that many eligible patients were not recruited.…”

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confidence: 99%

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Vugt

Broekhuizen

Zuithoff

et al. 2012

The Annals of Family Medicine

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PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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A Patient’s Viewpoint on a Current Controversy

Abstract: Editor:The article by Drs Freer and Ulissey (1) was recently brought to my attention. Since the statistical methods used in the article were an excellent example of how to emphasize CIs

Cited by 58 publications

References 4 publications

Clinical impact of the use of additional ultrasonography in diagnostic breast imaging

Clinical impact of the use of additional ultrasonography in diagnostic breast imaging

Lung Cancer Screening with CT

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

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