Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2010.06.013 Byline: Lincoln L. Berland (a), Stuart G. Silverman (b), Richard M. Gore (c), William W. Mayo-Smith (d), Alec J. Megibow (e), Judy Yee (f), James A. Brink (g), Mark E. Baker (h), Michael P. Federle (i), W. Dennis Foley (j), Isaac R. Francis (k), Brian R. Herts (h), Gary M. Israel (g), Glenn Krinsky (l), Joel F. Platt (k), William P. Shuman (m), Andrew J. Taylor (n) Keywords: Incidental findings; incidentaloma; pancreatic cyst; renal cyst; liver lesion; adrenal nodule Abstract: As multidetector CT has come to play a more central role in medical care and as CT image quality has improved, there has been an increase in the frequency of detecting 'incidental findings,' defined as findings that are unrelated to the clinical indication for the imaging examination performed. These 'incidentalomas,' as they are also called, often confound physicians and patients with how to manage them. Although it is known that most incidental findings are likely benign and often have little or no clinical significance, the inclination to evaluate them is often driven by physician and patient unwillingness to accept uncertainty, even given the rare possibility of an important diagnosis. The evaluation and surveillance of incidental findings have also been cited as among the causes for the increased utilization of cross-sectional imaging. Indeed, incidental findings may be serious, and hence, when and how to evaluate them are unclear. The workup of incidentalomas has varied widely by physician and region, and some standardization is desirable in light of the current need to limit costs and reduce risk to patients. Subjecting a patient with an incidentaloma to unnecessary testing and treatment can result in a potentially injurious and expensive cascade of tests and procedures. With the participation of other radiologic organizations listed herein, the ACR formed the Incidental Findings Committee to derive a practical and medically appropriate approach to managing incidental findings on CT scans of the abdomen and pelvis. The committee has used a consensus method based on repeated reviews and revisions of this document and a collective review and interpretation of relevant literature. This white paper provides guidance developed by this committee for addressing incidental findings in the kidneys, liver, adrenal glands, and pancreas. Author Affiliation: (a) Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama (b) Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (c) Department of Radiology, Evanston Hospital, Evanston, Illinois (d) Department of Radiology, Brown University School of Medicine, Providence, Rhode Island (e) Department of Radiology, NYU-Langone Medical Center, New York, New York (f) Department of Radiology, University of California, San Francisco, San Francisco, California (g) Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut (h) Department of Radiology, Cleveland Clinic, Cleveland, Ohio (i) Department of Radiology, Stanford University Medical Center, Stanford, California (j) Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin (k) Department of Radiology, University of Michigan, Ann Arbor, Michigan (l) Radiology Associates of Ridgewood, PA, Waldwick, New Jersey (m) Department of Radiology, University of Washington School of Medicine, Seattle, Washington (n) Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia