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Review
. 2008 Summer;36(2):320-31, 213.
doi: 10.1111/j.1748-720X.2008.00276.x.

Incidental findings in CT colonography: literature review and survey of current research practice

Hassan Siddiki  1 , J G Fletcher, Beth McFarland, Nora Dajani, Nicholas Orme, Barbara Koenig, Marguerite Strobel, Susan M Wolf
Affiliations
Review

Incidental findings in CT colonography: literature review and survey of current research practice

Hassan Siddiki et al. J Law Med Ethics. 2008 Summer.

Abstract

Incidental findings (IFs) of potential medical significance are seen in approximately 5-8 percent of asymptomatic subjects and 16 percent of symptomatic subjects participating in large computed tomography (CT) colonography (CTC) studies, with the incidence varying further by CT acquisition technique. While most CTC research programs have a well-defined plan to detect and disclose IFs, such plans are largely communicated only verbally. Written consent documents should also inform subjects of how IFs of potential medical significance will be detected and reported in CTC research studies.

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Figures

Figure 1
Figure 1
69-year-old male ex-smoker with a history of pulmonary fibrosis underwent CT colonography for research purposes. The transverse image of the lower chest shows a large pulmonary nodule with cavitation (arrow). The biopsy demonstrated multifocal squamous cell carcinoma. The subject was not a candidate for any curative therapy, and he died within six months, succumbing to different pulmonary complications. In this instance, the discovery of a significant incidental finding resulted in lead time bias, and no change in mortality.
Figure 2
Figure 2
50-year-old asymptomatic male with no comorbidities underwent CT colonography for research purposes. The transverse image of the abdomen shows incidentally noted mesenteric adenopathy (arrows pointing to enlarged lymph nodes). The colon itself was negative for any precancerous lesions. A CT-guided biopsy demonstrated follicular B-cell lymphoma. The subject was treated with chemotherapy and responded with complete remission. He continues to be completely free of disease after seven years.
Figure 3
Figure 3
57-year-old asymptomatic female with no comorbidities underwent CT colonography for research purposes. The transverse image of the abdomen shows 4 cm cystic adnexal structure in the pelvis. The colon itself was negative for any precancerous lesions. Following the identification of this significant incidental finding, a transvaginal ultrasound was performed, which showed septations suspicious for a malignant, cystic ovarian neoplasm. She underwent a bilateral salpingo-oophorectomy without complication, with histopathology demonstrating a benign ovarian serous cystadenoma.
Figure 4
Figure 4
73-year-old asymptomatic male with no comorbidities underwent CT colonography for research purposes. The transverse image of the abdomen shows incidentally found 3.3 cm aortic aneurysm. The primary physician was communicated, and the patient was advised to seek annual ultrasound surveillance of the aortic aneurysm.
Figure 5
Figure 5
57-year-old asymptomatic male underwent CT colonography for research purposes. The transverse image of the abdomen shows a 6.5 cm simple renal cyst that was categorized as an insignificant finding. No follow-up was recommended.
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References

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    1. Wolf SM, et al. Managing Incidental Findings in Human Subjects Research: Analysis and Recommendations. Journal of Law, Medicine & Ethics. 2008;36(2):219–248. - PMC - PubMed

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