title: Frequency and clinical significance of previously undetected incidental findings detected on computed tomography simulation scans for breast cancer patients.
abstract: OBJECTIVE
  To determine the frequency and clinical significance of previously undetected incidental findings found on computed tomography (CT) simulation images for breast cancer patients.
  
  
  METHODS
  All CT simulation images were first interpreted prospectively by radiation oncologists and then double-checked by diagnostic radiologists. The official reports of CT simulation images for 881 consecutive postoperative breast cancer patients from 2009 to 2010 were retrospectively reviewed. Potentially important incidental findings (PIIFs) were defined as any previously undetected benign or malignancy-related findings requiring further medical follow-up or investigation. For all patients in whom a PIIF was detected, we reviewed the clinical records to determine the clinical significance of the PIIF. If the findings from the additional studies prompted by a PIIF required a change in management, the PIIF was also recorded as a clinically important incidental finding (CIIF).
  
  
  RESULTS
  There were a total of 57 (6%) PIIFs. The 57 patients in whom a PIIF was detected were followed for a median of 17 months (range, 3-26). Six cases of CIIFs (0.7% of total) were detected. Of the six CIIFs, three (50%) cases had not been noted by the radiation oncologist until the diagnostic radiologist detected the finding. On multivariate analysis, previous CT examination was an independent predictor for PIIF (p = 0.04). Patients who had not previously received chest CT examinations within 1 year had a statistically significantly higher risk of PIIF than those who had received CT examinations within 6 months (odds ratio, 3.54; 95% confidence interval, 1.32-9.50; p = 0.01).
  
  
  CONCLUSIONS
  The rate of incidental findings prompting a change in management was low. However, radiation oncologists appear to have some difficulty in detecting incidental findings that require a change in management. Considering cost, it may be reasonable that routine interpretations are given to those who have not received previous chest CT examinations within 1 year.
authors.affiliation: Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan. naokinak@luke.or.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsunoda
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Mari
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Honda
authors.forename: Naoto
authors.initials: N
authors.lastname: Shikama
authors.forename: Keiko
authors.initials: K
authors.lastname: Akahane
authors.forename: Kenji
authors.initials: K
authors.lastname: Sekiguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008080:Liposarcoma / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000000981:diagnostic imaging; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging; D011184:Postoperative Period; D018787:Radiation Oncology / Q000706:statistics & numerical data; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult