A Closer Look at Incidentalomas

Dr. Israeli and I co-wrote an article that was recently accepted for publication in the leading plastic surgery journal, Plastic and Reconstructive Surgery, looking at the rates of incidental findings during CT scans of women planning to undergo DIEP flap breast reconstruction.

Sometimes, preoperative CT scans reveal something unexpected. These incidental findings, called incidentalomas, can impact patient management and patient anxiety.

I had the idea to investigate this aspect of our practice, since during training, we very rarely obtained CT scans. In our practice, however, we routinely perform CT angiograms of the abdomen, which is a CT scan of the belly that helps us identify the blood vessels we need to access during surgery, on all patients planning to undergo DIEP Flap Breast Reconstruction. The scans help us create a surgical anatomy roadmap, which helps with surgical planning and increases operative efficiency.

We looked at nearly 500 CT scans performed over several years, reviewed the radiology reports, and recorded any unexpected findings. Over two thirds of those scans revealed one or more unexpected findings. The study cohort included more than 35 different types of findings, nearly all of which were benign. However, 2.4-percent of those findings required additional investigations.

We concluded that there is a high likelihood of incidental findings on preoperative CT scans, those findings tend to be benign, and their impact on surgical planning is minimal.