Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee

Berland, Lincoln L.; Silverman, Stuart G.; Gore, Richard M.; Mayo-Smith, William W.; Megibow, Alec J.; Yee, Judy; Brink, James A.; Baker, Mark E.; Federle, Michael P.; Foley, W. Dennis; Francis, Isaac R.; Herts, Brian R.; Israel, Gary M.; Krinsky, Glenn A.; Platt, Joel F.; Shuman, William P.; Taylor, Andrew

doi:10.1016/j.jacr.2010.06.013

Cited by 758 publications

(447 citation statements)

References 106 publications

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“…In patients with no history of cancer and an adrenal mass >4 cm in size, with no benign features, resection should be considered as this finding is suspicious for an adrenal cortical carcinoma; if there is a history of prior cancer, then a PET/CT scan and as indicated, a biopsy is recommended [35].…”

Section: Key Pointsmentioning

confidence: 99%

Adrenal Imaging

Francis¹,

Mayo-Smith²

2018

IDKD Springer Series

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Section: Key Pointsmentioning

confidence: 99%

Adrenal Imaging

Francis¹,

Mayo-Smith²

2018

IDKD Springer Series

Self Cite

View full text Add to dashboard Cite

“…A typical example would be a scan ordered to assess the kidneys, which necessarily includes the adrenal glands (present at the top of the kidneys). 27 If a lesion is present in the adrenal gland, the radiologist cannot avoid seeing it even if the examination was undertaken only because of suspected kidney disease. Most such incidentalomas prove benign but can trigger expensive anxiety-inducing work-ups.…”

Section: Comparison With Incidental Findings In Other Areas Of Medicinementioning

confidence: 99%

Reporting Incidental Findings in Genomic Scale Clinical Sequencing—A Clinical Laboratory Perspective

Hegde

Bale²,

Bayrak-Toydemir

et al. 2015

The Journal of Molecular Diagnostics

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Advances in sequencing technologies have facilitated concurrent testing for many disorders, and the results generated may provide information about a patient's health that is unrelated to the clinical indication, commonly referred to as incidental findings. This is a paradigm shift from traditional genetic testing in which testing and reporting are tailored to a patient's specific clinical condition. Clinical laboratories and physicians are wrestling with this increased complexity in genomic testing and reporting of the incidental findings to patients. An enormous amount of discussion has taken place since the release of a set of recommendations from the American College of Medical Genetics and Genomics. This discussion has largely focused on the content of the incidental findings, but the laboratory perspective and patient autonomy have been overlooked. This report by the Association of Molecular Pathology workgroup discusses the pros and cons of nextgeneration sequencing technology, potential benefits, and harms for reporting of incidental findings, including the effect on both the laboratory and the patient, and compares those with other areas of medicine. The importance of genetic counseling to preserve patient autonomy is also reviewed. The discussion and recommendations presented by the workgroup underline the need for continued research and discussion among all stakeholders to improve our understanding of the effect of different policies on patients, providers, and laboratories. (J Mol Diagn 2015, 17: 107e117; http://dx

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“…Readers who wish to further review recommendations on incidental adrenal masses are encouraged to review the ''White Paper'' recently published by the American College of Radiology. 42 MRI using in-phase and opposed-phase images, known as ''chemical-shift MRI,'' is an alternative modality to CT for adrenal mass characterization. Based on the presumption that benign adrenal masses contain more intracytoplasmic lipid than malignant, quantitative analysis can be made solely using different adrenal phases over large regions of interest, known as Adrenal Signal Intensity Index or ASII.…”

Section: Lung Cancer and Adrenal Metastasismentioning

confidence: 99%

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

Stone

Wymer

Canales

2014

Journal of Endourology

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Background and Purpose: Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. Patients and Methods: Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. Results: Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. Conclusions: Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ‡ 10 mm with high PET maximum SUV ( ‡ 3.1) and SUV ratios ( > 2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.

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Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee

Cited by 758 publications

References 106 publications

Adrenal Imaging

Adrenal Imaging

Reporting Incidental Findings in Genomic Scale Clinical Sequencing—A Clinical Laboratory Perspective

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

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