Harvard Health Letter

What to do about incidental findings

They often lead to follow-up appointments and more testing.

Modern medical imaging saves lives: it can find a blocked artery, a bulging blood vessel, or a suspicious mass. But many times, an x-ray, CT scan, MRI scan, or ultrasound exam looking for one kind of problem can reveal an anomaly that’s unrelated and unexpected. Such incidental findings can lead to more testing, more medical bills, and a great deal of anxiety.

“Frequently radiologists will point out something and say it’s probably benign, but recommend an MRI. Once you’ve been told something might be abnormal, you might feel nervous until you know what it is,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Examples

Incidental findings can show up in just about any part of the body, such as the brain, thyroid, lungs, kidneys, liver, pancreas, adrenal glands, or ovaries.

An incidental finding might be a nodule or tumor (abnormal growths that may be benign or malignant) or a cyst (a fluid-filled or debris-filled sac). “For example, the doctor may order a chest x-ray in a person with a bad cough, to look for pneumonia, but the radiologist finds a nodule instead. It may be totally benign, or it may be cancerous,” Dr. Salamon says. Even if the chance that the nodule is cancerous is very small, there is still a lot of anxiety and pressure to do further testing to be sure it’s not cancer.

What happens next?

The next steps depend on the shape, size, and location of the incidental finding. “There’s no way to generalize it,” Dr. Salamon says. “We have guidelines spelling out the sizes of cysts and nodules in each part of the body that require follow-ups.” The guidelines are based on good scientific studies, but they’re not perfect: sometimes a cyst or nodule that the guidelines recommend testing further turns out to be nothing, or a cyst or nodule that did not warrant further testing turns out to be serious.

Coping with consequences

Unfortunately, incidental findings can create hardship, including physical harm from invasive tests (such as biopsies), psychological harm (stress and anxiety), financial burdens, and strains on relationships (see “Consequences of incidental findings: Latest research”).

Most often incidental findings on imaging tests don’t represent anything serious. If it is a simple cyst, it likely won’t require any specific follow-up. For other findings, the radiologist may recommend a repeat test in three to six months, or even longer. But if your doctor urges you to get a follow-up test:

Schedule it now. The sooner you have answers, the better.

Listen to your doctor. “If the doctor is reassuring you that the results are probably going to be benign, try to focus on that,” Dr. Salamon suggests.

Try to be positive. “If the tests do show you have a serious condition, at least you’ll be finding it early,” Dr. Salamon says, “which means you’ll have a better chance for successful treatment.”

Consequences of incidental findings: Latest research

In a recent Harvard survey of almost 400 internal medicine physicians across the United States, published online Oct. 16, 2019, by JAMA Network Open, the doctors reported that pursuing incidental findings caused their patients psychological harm (68%), physical harm (16%), and financial burden (58%) — and also caused the patients wasted time and effort (69%), frustration (53%), and anxiety (45%). “As many as 22% of physicians reported dealing with incidental findings weekly, calling patients or ordering tests,” says Dr. Ishani Ganguli, lead author of the study and an internal medicine specialist with Harvard-affiliated Brigham and Women’s Hospital. Yet sometimes pursuing an incidental finding saved a life.

Our take

Medicine began using x-rays more than a century ago, but CT, MRI, and ultrasound have been around only about 50 years. These technologies have greatly improved diagnosis — particularly by catching bad diseases early — and even improved treatments by enabling doctors to guide a needle or scalpel more precisely.

Yet, like many beneficial inventions, they can have a downside. Doctors are working to improve the ability of these technologies to distinguish potential serious problems from irregularities that are of no concern.

Image: stevecoleimages/Getty Images

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