How Do You Solve a Problem Like Incidentalomas?

Leonard Berlin, MD, FACR


Appl Radiol. 2013;42(2):10-12. 

In This Article

Should We Ignore Incidentalomas?

Many radiologists and nonradiologic physicians believe we should not report incidentalomas if they appear benign.[9] As pointed out by 2 medical researchers, "Tests that provide information about unrelated conditions leave the physician and patient to contend with information they had not sought but which they find impossible to ignore; patients would be better served if physicians limited their access to unsolicited diagnostic information."[10]

Similar sentiments were echoed by a gastroenterologist: "It defies a basic tenet of medicine to question the benefit of diagnostic information, as any new piece of information regarding a patient's health is considered valuable and worthwhile having. But acquiring new knowledge can worsen a patient's overall well-being by leading to more aggravation, discomfort, and injury than the earlier state of ignorance. Even if the patient and physician decide to ignore the positive test, they may still harbor lingering doubts and fear that a potentially serious disease will go untreated. The physician may be concerned about being blamed for missing an important diagnosis and face future litigation."[11]

There is yet an additional problem with reporting every incidentaloma: overdiagnosis, defined as "diagnosis of an illness, disease, or cancer that never becomes symptomatic, is not fatal, and may continue until the individual dies from other causes."[12] In other words, radiologic exams have the potential to do harm by finding tumors that would not otherwise have required treatment, setting off a cascade of unnecessary tests and biopsies, sometimes resulting in complications. "It is like the lottery: In exchange for those few who win the lottery, there are many, many others who have to pay the price in human costs."[13]