These studies use inconsistent and often inappropriate synthesis methods, and commonly only focus on one imaging scan or organ. Several systematic reviews have been published exploring the prevalence and outcomes of incidentalomas. 3 12 Although some guidelines exist, 1 13 14 15 16 17 they are often directed at radiologists 15 16 17 and for many organs (eg, colon, spine, breast, brain, prostate, and parotid) there are no guidelines to address the management of incidentalomas. 11 It is difficult for clinicians to appropriately inform patients of the chance of incidental findings because the data quantifying prevalence is inconsistent and unclear.Д¬linicians have also expressed uncertainty about the ideal management of incidentalomas, particularly primary care physicians.

4 Despite this, informed consent before imaging remains poor. In response to the risks of incidentalomas, a US Presidential Commission encouraged clinicians to discuss with patients incidentalomas as a risk of imaging before they order a scan. 10 Given the clinical uncertainty surrounding their ideal management, they can encourage further investigations and potentially overtreatment. Incidentalomas are problematic because they can lead to patient anxiety. 4 The rapid rise in demand for imaging, 5 6 coupled with rapidly advancing image resolution is driving a surge in incidentalomas. Incidentalomas, incidental imaging findings serendipitously diagnosed in an asymptomatic patient or symptomatic patient undergoing imaging for an unrelated reason, 1 2 3 are fast becoming a modern medical crisis. Many assessments had high between-study heterogeneity (15 of 20 meta-analyses with I 2 >50%). Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. The rate of malignancy in incidentalomas varied substantially between organs the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Intermediate rates occurred with MRI of the spine (22%) and brain (22%). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extra-colonic incidentalomas).

The prevalence of incidentalomas varied substantially between imaging tests it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). 20 systematic reviews (240 primary studies) were identified from 7098 references from the database search.

Umbrella remix 2017