Some have suggested that reporting incidental extracardiac findings may lead to unnecessary follow-up studies and treatments, with their associated costs and possible harms. The cost-effectiveness of coronary CT angiography may hinge upon the downstream resource utilization for follow-up of incidental findings.
This retrospective study examined incidental extracardiac findings in 151 consecutive adults (mean age, 54; range, 18-83; 30.5% female) undergoing screening coronary CT angiography over a six-year period. Incidental findings were recorded and medical records reviewed for subsequent downstream diagnostic interventions for a minimum one-year and maximum seven-year follow-up period.
In all, 103 incidental extracardiac findings were found in 54% (65/151) of patients. Just over half (54/103) were potentially clinically significant, affecting 27% of patients. Specific recommendations for further follow-up were provided within the radiology report for 31% of new significant findings, but only 6% of patients actually received follow-up imaging or intervention.
Costs were modest based on Medicare reimbursement data, according to presenter Christoph Lee of Stanford University in Stanford, CA; however, "costs likely hinge upon the appropriate specific follow-up recommendations as reported in the radiology report and physician compliance in following written recommendations," he said.
Clinically significant extracardiac findings are common, but most are indeterminate pulmonary nodules. Improved radiologist-clinician communication practices would likely be helpful in minimizing the associated direct costs, he said.
