Dr. Jimmy MacHaalany from University of Ottawa Heart Institute, Ontario, Canada, and colleagues investigated the incidence of clinically significant and indeterminate noncardiac incidental findings among 966 patients referred for cardiac CT.
According to their report in the October 13 Journal of the American College of Cardiology, 401 patients (41.5%) had new noncardiac incidental findings. Most were pulmonary (54%), with pulmonary nodules accounting for 14% of all incidental findings.
Only 12 patients (1.2%) had incidental findings that required intervention.
Sixty-eight patients (7.0%) had indeterminate findings that required further diagnostic work-up, but none of these became clinically significant, the researchers note. During the course of their diagnostic work-ups, however, three patients were serendipitously diagnosed with malignancies unrelated to the incidental finding.
Incidental findings were not associated with a significant change in mortality, but the total direct cost of investigating all incidental findings (including the cost of treating the sole complication after transthoracic biopsy) exceeded $83,000.
"Larger studies are needed to better understand potential morbidity and mortality benefit of detecting incidental findings," the investigators say.
"Since there is no professional consensus about the approach to reading cardiac CT scans for noncardiac findings, we suggest that the patient's concerns and preferences should be taken into consideration, as they would in any 'close call,' " Dr. Mark Hlatky from Stanford University School of Medicine in Palo Alto, CA, and Dr. Carlos Iribarren from Kaiser Permanente of Northern California, Oakland, write in a related editorial.
"After being properly informed, the patient could then choose whether to 'opt in' or 'opt out' of having the noncardiac structures examined to search for incidental findings," the editorial concludes.
J Am Coll Cardiol 2009;54:1533-1541,1542-1543.
Last Updated: 2009-10-05 17:00:29 -0400 (Reuters Health)
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