Incidental Pulmonary Nodules Found on Shoulder Arthroplasty Preoperative CT Scans

Abstract

With current emphasis on preoperative templating of anatomical and reverse shoulder arthroplasty (aTSA and rTSA, respectively), patients often receive thin slice (<1.0 mm) computerized tomography (CT) scans of the operative shoulder, which includes about two-thirds of the ipsilateral lung. The purpose of this study is to evaluate the prevalence and management of incidentally detected pulmonary nodules on preoperative CT scans for shoulder arthroplasty. In this single-center retrospective study, we queried records of aTSA and rTSA patients from 2015 to 2020 who received preoperative CT imaging of the shoulder. Compared to patients with negative CT findings, there were significantly more females (63.8% vs. 46.4%; P = .011), COPD (13.0% vs. 4.7%; P = .015), and asthma (18.8% vs. 6.9%; P = .003) among the patients with incidental nodules on CT. Binary logistic regression confirmed that female sex (odds ratio = 2.00; 95% CI = 1.04 to 3.88; P = .037), COPD history (OR = 3.02; 95% CI = 1.05 to 8.65; P = .040), and asthma history (OR = 3.17; 95% CI = 1.30 to 7.77; P = .011) were significantly associated with an incidental nodule finding. Incidental pulmonary nodules found on shoulder arthroplasty preoperative CT scans are often low risk in size with low risk of malignancy, and do not require further workup. This study may provide guidance to orthopedic surgeons on how to manage patients with incidental pulmonary nodules to increase chances of early cancer detection, avoid unnecessary referrals, reduce potentially harmful radiation exposure of serial CT scans, and improve cost efficiency.

Rate of incidental findings on routine preoperative computed tomography for shoulder arthroplasty

“…Although this rate is similar to our reported overall rate of incidental findings (23.7%), the study by Lopez et al [ 8 ] was limited to pulmonary nodules and did not account for alternative incidental findings. Thus, the rate of pulmonary nodules reported by Lopez et al [ 8 ] is much higher than what was observed in our patient cohort, as only 59% of incidental findings were pulmonary in nature. Given our inclusion of all types of incidental findings, our study represents a valuable addition to the current literature on this subject.…”

“…Most published studies have focused on pulmonary incidental findings or aimed to compare the incidence of these findings on different imaging techniques. Lopez et al [ 8 ] demonstrated that 22.8% of patients undergoing TSA had pulmonary nodules incidentally detected on preoperative shoulder CT. Although this rate is similar to our reported overall rate of incidental findings (23.7%), the study by Lopez et al [ 8 ] was limited to pulmonary nodules and did not account for alternative incidental findings.…”

“…Lopez et al [ 8 ] demonstrated that 22.8% of patients undergoing TSA had pulmonary nodules incidentally detected on preoperative shoulder CT. Although this rate is similar to our reported overall rate of incidental findings (23.7%), the study by Lopez et al [ 8 ] was limited to pulmonary nodules and did not account for alternative incidental findings. Thus, the rate of pulmonary nodules reported by Lopez et al [ 8 ] is much higher than what was observed in our patient cohort, as only 59% of incidental findings were pulmonary in nature.…”

“…First, there is limited study regarding the rate of incidental findings on preoperative shoulder CT scans performed prior to shoulder arthroplasty. Some of the available published research on this topic focuses on pulmonary images or aims to investigate incidental findings of different CT techniques [ 8 , 9 ]. The limited nature of the literature on this topic limit conversations with patients regarding the significance and prevalence of incidental findings, particularly those outside of the pulmonary system.…”