I didn't find anything much about these during a search. Apologies if this is already covered
"An incidental finding is something extra found by the test. It's something not related to the reason your doctor ordered the test."
Many of us will be familiar with the incidental finding of CLL which is made when the purpose of the blood test is for something else.
There are other incidental findings thrown up by scans. The finding may be something significant. I have one from a CT scan that has the potential to be rather nasty.
I am posting this since in the past I had not thought much about a scan raising these and what my doctors might do about it. In my case my CLL consultant referred me directly to another Consultant who specializes in the contents of the finding.
I will certainly make sure in future to ask whether a scan or other test has given rise to something I should get looked at. Ya'll might want to consider doing the same when you get a scan or other test.
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ScruffyDuck
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My CLL was diagnosed as a result of a lung CT because I have the SLL version. I took part in a study for those classed as high risk for lung cancer. The purpose of the study was to establish if routine low dose CT scans for those at risk would lead to earlier diagnosis and a higher treatment success rate. Similar to mammogram screening. Lung screening is now done in Ontario for those who meet the high risk criteria.
Scans can frequently show unexpected incidental findings and this warning was given at the start of the trial. There has been a lot of debate as to whether routine scans can lead to unnecessary and expensive testing which can cause extreme unwarranted anxiety for many people. False positives do happen.
Where I live all scan reports have a RADS score (Reporting and Data System), a classification system for findings in low-dose CT screening exams. Each finding is given a score & that score determines any follow up recommended.
I have a Bi-RADS (breast) & Lung-RADS score. Now I only ask what my score is because that tells me everything is stable. The score is at the end of each report.
The enlarged lymph nodes had been deep in my chest for some time but it was only when they grew in size beyond expected parameters that further investigation was ordered.
If you have access to the radiology report, you will likely find your score. A referral doesn't automatically mean the worst.
Incidental findings can be a blessing in that potential health concerns can be identified and addressed earlier, but they can be a curse if you have an anxious temperament.
Incidental Test Findings and the Burden They Create
I'm an anxious guy, and I've really worked on finding perspective on incidental findings over the years.
As a retired IT person, I am reminded how we troubleshoot problems on devices. There's usually the initial complaint from a user or operator. Based on experience, we begin looking around the software controls and indicators. At some point, we look into the log files that each device keeps. Beware of this if you have never looked at a log file. There are so many incidental things, most of which do not relate to the problem at hand, and most of which are not significant even though some programmer decided it was important enough to create the log entry. There are things marked Error that are insignificant, there are things marked Informational that are significant, depending on other log entries.
So it is with the body and our diagnostic tests. The body has a wide range a tissues and fluids. We can measure many of them easily, and some take some effort or pain to measure. Some cannot be measured easily at all. Some norms have been created for the easy ones to guide doctors. The people who establish the norms had to cast a wide enough net, and often come up with very mechanical statistical strategies. Their intention is almost never that the norms and their measurements always indicate disease, but that they might indicate disease in some cases. The measurements always, always have to be interpreted along with other measurements, signs, and symptoms.
I'm in a clinical trial, and I get so many blood tests, bone marrow biopsies, and CT scans. CT scans in particular produce incidental findings that depend greatly on the radiologist reading the image. What's interesting to one radiologist my be ignored by another. Some radiologists are meticulous and look at previous imaging reports to see if an indication is still there and then comment on it if it is or it isn't. Some do not. The radiologist usually has a basic diagnosis in the request for reading the image. Some have access to the patient records, some do not. On a trial, they do have access, and may be particularly aware of drug side effects on liver and kidneys, as well as things that might appear that a patient might report as a pain symptom, such as spinal changes.
So I've had to chase some things from CTs. My doctors were particularly worried about fatty liver indications. I had had that indication long ago on a CT at my local hospital, and it wasn't clear if it had gotten worse. I ended up doing an elastography ultrasound at my gastro enterologist, which reported that it really wasn't bad at all. My primary care commented that many of his patients at my age had some fatty liver, but almost never saw changes on liver enzymes or progressed to cirrhosis.
One radiologist at M.D. Anderson also noticed a small 1.3cm aneurism in the distal celiac artery. I learned that when I go to get a CT scan at my local hospital, I can write things to look for on my patient survey (which differs a lot from clinic to clinic), and I mentioned the dates of previous studies. So I wrote that, as well as my last lymph node seen during the trial, and the radiologist did not see either. So did the aneurism disappear? Is it a matter of judgement? Blurriness? I don't know, but I'm glad they weren't seen. If 2 different radiologists see something, it's probably reallt there.
There's a trend toward full body scans. In Japan, they've been doing them for years. I imagine that Japanese radiologists have different triggers for what to mention than American ones do. As with all tests, there's specificity vs sensitivity - false negatives vs false positives. I think the more tests we do, the more we find that the unusual stuff is a false positive.
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