Incidentalomas: managing risks

Radiol Bras. 2015 Jul/Ago;48(4):IX–X Incidentaloma is the medical term for incidentally found asymptomatic tumors. Such imaging findings have been increasingly frequent as the use of sectional imaging methods is disseminated. Its incidence can hardly be established, but it is known that pulmonary nodules may be identified at up to 50% of chest computed tomography (CT) studies in smoking individuals and at up to 25% of studies of non-smokers. At CT colonography, incidental findings are identified in up to 70% of patients and, at abdominal CT, renal and hepatic findings occur in about 15% of the individuals . Also, asymptomatic nodules are identified in up to 67% of individuals submitted to thyroid ultrasonography. Incidental imaging findings such as aortic aneurysms may be clinically significant, determining interventions that may change the natural course of the disease. However, most incidental findings constitute a form of overdiagnosis. Overdiagnosis is the diagnosis of a disease that never will cause symptoms or death of the patient, and is nowadays considered to be a public health problem. Usually, such diagnoses refer either to lesions with a benign nature or to least aggressive malignant lesions. Some cancers do not progress or are so indolent that will never produce symptoms in the patients who will die for other causes. The uncertainty and anxiety may lead to the automatic adoption of investigative measures with the objective of identifying the nature of any lesion that might even remotely represent a cancer. Such investigations, even imbued with the best intentions, may cause morbidity and even death in individuals who have harmless lesions. A pediatric neurosurgeon has defined a new acronym to describe the risks associated with incidental imaging findings: VOMIT – victims of modern imaging technologies. In a letter to the Editor published in the Radiology journal, a radiologist, Dr. William J. Casarella, reported his personal experience with incidentalomas, starting with a virtual colonoscopy indicated in his routine check-up, that did not revealed any finding in his bowels. However, other findings triggered further investigations, percutaneous biopsy, videothoracoscopy, requiring some days in a hospital and a few weeks for him to get recovered. The experience has led Dr. Casarella to call his peers’ attention to the potential risks caused by incidental findings. The management of incidental findings represents a clinical dilemma, but it is also influenced by other factors, such as cul-