CLO19-046: Follow-Up and Diagnosis of Breast Incidentalomas on Abdominal and Chest MRI

With the increasing use of medical imaging, it is important to report and appropriately recommend work up for incidental findings. The aim of the study was to understand how often incidental breast findings are identified on MRI chest/abdomen protocols, how these findings are followed, and the final diagnosis (benign vs malignant) of these lesions. A single institution retrospective review was performed of women who underwent abdominal or chest MRI from January 2007–January 2017 for a non–breast cancer reason with a radiologic report containing the key word “breast.” Incidental breast findings were defined as lesions not known or suspected prior to imaging. For all patients where a breast lesion was identified, the radiologic reports, follow-up imaging and procedures, and final breast pathology were reviewed. Descriptive points were analyzed using counts and percentages versus mean with standard deviation where applicable. After review, 261 patients met inclusion and exclusion criteria with demographics in Table 1. Most patients (92%) had a known or benign breast finding, but 8% (n=21) had a breast finding for which follow-up was recommended. Recommendation for follow-up included ultrasound (n=4), mammogram (n=8), per clinician (n=14), and breast MRI (n=2). Only 7/21 (33.3%) completed recommended follow-up: 86% (6/7) had normal imaging and 14% (1/7) had a new breast cancer diagnosed. Thus, the rate of new breast cancer diagnosis from abnormal abdominal or chest MRI was 4.7%. Recommendation for specific imaging follow-up (56%) (mammogram/ultrasound/MRI) in the original MRI report was 39% more likely to be completed versus “per clinician” (17%) recommendation (P=.15). Incidental breast findings on abdominal and chest MRI are uncommon, but follow-up is important to exclude new breast cancer diagnosis. Specific imaging recommendations (versus “per clinician”) appeared to improve rate of follow-up. Prior studies have looked at incidental breast findings on CT but few have assessed breast incidentalomas on abdominal MRIs, with similar rates of new breast cancer diagnosis documented in our study. Studies assessing breast incidentalomas on chest MRIs are lacking. Going forward, multi-institutional studies may further define the rate of breast cancer diagnosis after breast incidentalomas identified on abdominal/chest MRI. In addition, studies focusing on improving follow-up imaging rates are important for patient safety and quality of care.

Abstract

With the increasing use of medical imaging, it is important to report and appropriately recommend work up for incidental findings. The aim of the study was to understand how often incidental breast findings are identified on MRI chest/abdomen protocols, how these findings are followed, and the final diagnosis (benign vs malignant) of these lesions. A single institution retrospective review was performed of women who underwent abdominal or chest MRI from January 2007–January 2017 for a non–breast cancer reason with a radiologic report containing the key word “breast.” Incidental breast findings were defined as lesions not known or suspected prior to imaging. For all patients where a breast lesion was identified, the radiologic reports, follow-up imaging and procedures, and final breast pathology were reviewed. Descriptive points were analyzed using counts and percentages versus mean with standard deviation where applicable. After review, 261 patients met inclusion and exclusion criteria with demographics in Table 1. Most patients (92%) had a known or benign breast finding, but 8% (n=21) had a breast finding for which follow-up was recommended. Recommendation for follow-up included ultrasound (n=4), mammogram (n=8), per clinician (n=14), and breast MRI (n=2). Only 7/21 (33.3%) completed recommended follow-up: 86% (6/7) had normal imaging and 14% (1/7) had a new breast cancer diagnosed. Thus, the rate of new breast cancer diagnosis from abnormal abdominal or chest MRI was 4.7%. Recommendation for specific imaging follow-up (56%) (mammogram/ultrasound/MRI) in the original MRI report was 39% more likely to be completed versus “per clinician” (17%) recommendation (P=.15). Incidental breast findings on abdominal and chest MRI are uncommon, but follow-up is important to exclude new breast cancer diagnosis. Specific imaging recommendations (versus “per clinician”) appeared to improve rate of follow-up. Prior studies have looked at incidental breast findings on CT but few have assessed breast incidentalomas on abdominal MRIs, with similar rates of new breast cancer diagnosis documented in our study. Studies assessing breast incidentalomas on chest MRIs are lacking. Going forward, multi-institutional studies may further define the rate of breast cancer diagnosis after breast incidentalomas identified on abdominal/chest MRI. In addition, studies focusing on improving follow-up imaging rates are important for patient safety and quality of care.

With the increasing use of medical imaging, it is important to report and appropriately recommend work up for incidental findings. The aim of the study was to understand how often incidental breast findings are identified on MRI chest/abdomen protocols, how these findings are followed, and the final diagnosis (benign vs malignant) of these lesions. A single institution retrospective review was performed of women who underwent abdominal or chest MRI from January 2007–January 2017 for a non–breast cancer reason with a radiologic report containing the key word “breast.” Incidental breast findings were defined as lesions not known or suspected prior to imaging. For all patients where a breast lesion was identified, the radiologic reports, follow-up imaging and procedures, and final breast pathology were reviewed. Descriptive points were analyzed using counts and percentages versus mean with standard deviation where applicable. After review, 261 patients met inclusion and exclusion criteria with demographics in Table 1. Most patients (92%) had a known or benign breast finding, but 8% (n=21) had a breast finding for which follow-up was recommended. Recommendation for follow-up included ultrasound (n=4), mammogram (n=8), per clinician (n=14), and breast MRI (n=2). Only 7/21 (33.3%) completed recommended follow-up: 86% (6/7) had normal imaging and 14% (1/7) had a new breast cancer diagnosed. Thus, the rate of new breast cancer diagnosis from abnormal abdominal or chest MRI was 4.7%. Recommendation for specific imaging follow-up (56%) (mammogram/ultrasound/MRI) in the original MRI report was 39% more likely to be completed versus “per clinician” (17%) recommendation (P=.15). Incidental breast findings on abdominal and chest MRI are uncommon, but follow-up is important to exclude new breast cancer diagnosis. Specific imaging recommendations (versus “per clinician”) appeared to improve rate of follow-up. Prior studies have looked at incidental breast findings on CT but few have assessed breast incidentalomas on abdominal MRIs, with similar rates of new breast cancer diagnosis documented in our study. Studies assessing breast incidentalomas on chest MRIs are lacking. Going forward, multi-institutional studies may further define the rate of breast cancer diagnosis after breast incidentalomas identified on abdominal/chest MRI. In addition, studies focusing on improving follow-up imaging rates are important for patient safety and quality of care.

T1

Corresponding Author: Samantha Acacia Rios, BS

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