JACR: Rads find little common ground on incidental findings

Radiologists are often not on the same page when it comes to the management of incidental findings on body CT scans, according to a study published in the November issue of the Journal of the American College of Radiology.

“The purpose of our study was to evaluate for agreement among body CT attending radiologists, both within departments and across academic institutions, for the management of a number of commonly encountered incidental findings on body CT,” Pamela T. Johnson, MD, of the department of radiology at Johns Hopkins Hospital in Baltimore, said in a statement.

Researchers administered a multiple-choice survey to 27 radiologists at three separate academic institutions, asking them how they would handle 12 incidental findings on body CT. Results showed that 70 percent or greater agreement on interpretation was identified for only six findings.

The mean experience level of the surveyed radiologists was 15.7 years after training, though even experienced radiologists found limited common ground on their interpretations. Agreement rates among radiologists with 10 years experience in practice after residency was higher in only half of the incidental findings when compared with agreement rates for the survey respondents as a whole. In five of the incidental finding scenarios, there was less agreement among experienced radiologists compared with the survey group as a whole.

Among the indications for which there was a strong lack of agreement were incidentally detected high-density renal cysts, small enhancing liver lesions, ovarian cysts in premenopausal women and focal gallbladder wall calcification.

“What is surprising is the lack of uniformity within individual departments for the most part,” wrote the authors, who added that it would be useful for major societies to take a more active role in defining guidelines.

The six recommendations with the most agreement were:

• Ultrasound for  a 1-cm thyroid nodule;
• Ultrasound for a 3-cm cyst in postmenopausal woman;
• Follow Fleischner Society recommendations for a 5-mm lung nodule;
• Describe coronary calcification, but provide no recommendation;
• Describe short-segment small bowel intussusception as likely benign; and
• Describe 1-cm splenic cyst as likely benign.

“It is important to note that at present, 100 percent agreement was not identified for the management of any of the 12 findings. An equally essential discovery is the lack of agreement across academic institutions and even within individual institutions for other incidental findings,” said Johnson.

Johnson added that the findings reveal a need for individual departments to develop internal guidelines to ensure consistent, evidence-based recommendations.