Incidental findings in imaging diagnostic tests: a systematic review

Area of Science:

• Radiology and Medical Imaging
• Evidence Synthesis
• Clinical Diagnostics

Background:

• Incidental findings are common in diagnostic imaging.
• Optimal management strategies for these findings remain undefined.
• Understanding their frequency and confirmation rates is crucial for patient care.

Purpose of the Study:

• To systematically review the literature on the frequency of incidental findings in diagnostic imaging.
• To summarize current evidence on the management and clinical confirmation of these findings.
• To identify factors influencing the occurrence of incidental findings.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and Cochrane Library Plus.
• Inclusion of 44 original articles after screening 251 abstracts.
• Data extraction on study design, imaging modality, diagnosis, incidental finding characteristics, and follow-up outcomes.
• Statistical analysis using one-way ANOVA to assess relationships between variables.

Main Results:

• The overall mean frequency of incidental findings was 23.6%.
• Higher frequencies were observed with CT scans (31.1%), unspecific initial diagnoses (30.5%), and unspecified locations (33.9%).
• Clinical follow-up occurred in 64.5% of cases, with a mean confirmation rate of 45.6%.

Conclusions:

• Incidental findings are prevalent in diagnostic imaging, particularly with CT.
• Current management lacks clear optimal strategies, evidenced by low clinical confirmation rates.
• Awareness of low confirmation rates for significant incidental findings is essential for clinical practice.