On-call abdominal ultrasonography: the rate of negative examinations and incidentalomas in a European tertiary care center

Abstract

Objectives To determine the proportions of abdominal US examinations during on-call hours that are negative and that contain an incidentaloma, and to explore temporal changes and determinants. Methods This study included 1615 US examinations that were done during on-call hours at a tertiary care center between 2005 and 2017. Results The total proportion of negative US examinations was 49.2% (795/1615). The total proportion of US examinations with an incidentaloma was 8.0% (130/1615). There were no significant temporal changes in either one of these proportions. The likelihood of a negative US examination was significantly higher when requested by anesthesiology [odds ratio (OR) 2.609, P = 0.011], or when the indication for US was focused on gallbladder and biliary ducts (OR 1.556, P = 0.007), transplant (OR 2.371, P = 0.005), trauma (OR 3.274, P < 0.001), or urolithiasis/postrenal obstruction (OR 3.366, P < 0.001). In contrast, US examinations were significantly less likely to be negative when requested by urology (OR 0.423, P = 0.014), or when the indication for US was acute oncology (OR 0.207, P = 0.045) or appendicitis (OR 0.260, P < 0.001). The likelihood of an incidentaloma on US was significantly higher in older patients (OR 1.020 per year of age increase, P < 0.001) or when the liver was evaluated with US (OR 3.522, P < 0.001). Discussion Nearly 50% of abdominal US examinations during on-call hours are negative, and 8% reveal an incidentaloma. Requesting specialty and indication for US affect the likelihood of a negative examination, and higher patient age and liver evaluations increase the chance of detecting an incidentaloma in this setting. These data may potentially be used to improve clinical reasoning and restrain overutilization of imaging.

An approach to managing gallbladder polyps for the general practitioner

“…1 Conservative estimates based on older analysis of general practitioner (GP) imaging-requesting behaviour would suggest that GPs were responsible for at least 250,000 abdominal ultrasounds during this period. 2,3 Of these abdominal ultrasounds, close to 0.5% will reveal an incidental finding of the gallbladder or biliary tract, 4 including cholelithiasis, choledocolithiasis, biliary duct dilatation, porcelain gallbladder, sludge, adenomyomatosis, cholesterolosis, gallbladder cancer (GBC) and gallbladder polyps (GBPs). 5 There is no consensus among radiologists on the reporting of these incidental findings and their respective follow-up, and there is an increasing onus on GPs to be aware of these incidental findings and to follow them up appropriately.…”