Managing Incidentalomas Safely: Do Computed Tomography Requisitions Tell Us What We Need to Know?

Abstract

A significant number of requisitions failed to disclose a history of cancer. Without knowledge of prior malignancy, radiologists cannot comply with current guidelines regarding the reporting and management of incidental findings.

Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews

“…This process poses challenges in certain jurisdictions, where logistical constraints or limited access to previous imaging studies hinder the ability to accurately assess temporal evolution of IPNs. This has been documented in the literature ( 50 ). KOLs noted that in some provinces, all publicly funded imaging is available on a single imaging network, but in other provinces, nearby hospitals use separate imaging networks making comparison with prior imaging cumbersome.…”

“…While the KOL interviews were structured to obtain personal clinical experience and opinion, rather than quantitative data, many of the KOL opinions are supported by the literature. For example, the frustration noted by the radiologist KOLs regarding clinical information that is insufficient to allow specific IPN management recommendations mirrors multiple publications documenting poor requisitions as a contributor to medical error ( 50 , 54 - 56 ). Expanded use of electronic medical records may help solve some of the issues regarding missing information on radiology requisitions by automatically populating the missing fields ( 57 ).…”

“…Interviewed experts agreed that standardized radiology reports would be beneficial and highlighted success where implemented. In Canada, the use of standardized radiology reporting is usually at the discretion of the individual radiologist ( 50 ). Implementation of standardized radiology reporting at a larger scale across the country may be supported by non-radiologist physicians.…”

Screening for second malignancies in mycosis fungoides: non‐Hodgkin lymphoma, Hodgkin lymphoma, lung cancer, bladder cancer and melanoma

“…The risks of radiation exposure and identification of 'incidentalomas' must be weighed against the benefits of early identification of lung cancer. [25][26][27] It is critical to ensure that patients are receiving their age and history appropriate lung cancer screenings as indicated by USPSTF guidelines. At this time, further additional imaging studies to screen for lung cancer clearly not indicated for patients with MF, although further exploration of this topic is necessary.…”

“…However, in comparison with the increased risk development of lung cancer in smokers (SIR 23.4‐302.0) 24 our SIR of 1.89‐8.24 is relatively low. The risks of radiation exposure and identification of ‘incidentalomas’ must be weighed against the benefits of early identification of lung cancer 25‐27 . It is critical to ensure that patients are receiving their age and history appropriate lung cancer screenings as indicated by USPSTF guidelines.…”