title: Incidental findings in CT angiograms for free DIEP flap breast reconstruction - Do they change our management?
abstract: BACKGROUND
  Abdominal CT angiography (CTA) has become an integral part of the pre-operative evaluation of patients undergoing free Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. It aids accurate delineation of perforator anatomy, assists pre-operative decision making and reduces operative time. However, such detailed imaging invariably yields a variety of incidental findings, with quoted figures of 13-36% in this setting. The purpose of this study was to identify the rate of "incidentalomas" when using DIEP CT angiography and, review how such findings influence our management.
  
  
  METHODS
  A retrospective review was performed, looking at pre-operative scan reports of 154 consecutive patients undergoing free DIEP flap breast reconstructions between July 2008 and June 2012.
  
  
  RESULTS
  Of 154 CTA's reviewed, 116 (75.3%) demonstrated incidental findings. In 71 patients (46.1%), these "incidentalomas" were inconsequential. However, in 37 patients (24.0%) the CTA prompted further investigations, and notably in a further 8 patients (5.2%) metastatic disease or other significant pathology was discovered which changed the operative plan.
  
  
  CONCLUSIONS
  The overall rate of "incidentalomas" presented in this study is substantially higher than other similar published series, and most importantly, significantly altered the surgical management plan in 5.2% of cases. As such we would advocate that a pre-operative "staging" CTA, imaging the chest, abdomen and pelvis is useful for more than just delineation of vascular anatomy in patients undergoing DIEP flap reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK. Electronic address: julianahughes@doctors.org.uk.
authors.forename: J M F
authors.initials: JM
authors.lastname: Hughes
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK.
authors.forename: J R O
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Department of Radiology, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK.
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003657:Decision Making; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000637:transplantation; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007430:Intraoperative Care / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Angiography; Breast reconstruction; Computed tomography; DIEP; Free tissue transfer; Incidental finding