Tevlin Ruth, Borrelli Mimi R, Nguyen Dung, Momeni Arash
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, Calif.
Plast Reconstr Surg Glob Open. 2018 Dec 12;6(12):e2019. doi: 10.1097/GOX.0000000000002019. eCollection 2018 Dec.
Incidentalomas are lesions found coincidentally during examination, imaging, or surgical procedures. Preoperative computed tomography angiography (CTA) before abdominal flap harvest for breast reconstruction can lead to identification of incidentalomas leading to the need for further investigations. The aim of this study was to examine the prevalence of incidental findings on preoperative CTA and to determine their impact on management.
A retrospective chart review was performed at a single tertiary institution. CTA reports were analyzed for the presence of incidental findings and details of follow-up were studied. Logistic regression was used to identify factors associated with incidental findings.
One hundred eighteen patients with a mean age of 49 years were included in the study. The majority of patients underwent bilateral reconstruction (65%, n = 77) in the immediate setting (70%, n = 83). Fifty-six percentage had an incidental finding on CTA, with hepatic (20%), renal (14%), and osseous (11%) abnormalities being most common. Additional imaging including ultrasound, CT, and magnetic resonance imaging were recommended in 19 cases (16%). Additional consultations were sought for 3 patients before reconstruction (with suspicion of bone metastases, an intraabdominal mass, and suspicion of colonic malignancy, respectively). No significant surgical delay secondary to CT findings was noted.
Incidentalomas following preoperative CTA of the abdomen/pelvis are common (56%). However, unlike previous reports, we did not observe a change in reconstructive plan following incidentaloma discovery. We recommend that all patients are counseled pre-CTA regarding the possibilities of incidentaloma detection and need for additional imaging.
偶发瘤是在检查、影像学检查或外科手术过程中偶然发现的病变。用于乳房重建的腹部皮瓣切取术前的计算机断层扫描血管造影（CTA）可能会发现偶发瘤，从而需要进一步检查。本研究的目的是检查术前CTA上偶发发现的发生率，并确定它们对治疗管理的影响。
在一家单一的三级医疗机构进行了一项回顾性病历审查。分析CTA报告中偶发发现的情况，并研究随访细节。采用逻辑回归分析来确定与偶发发现相关的因素。
118例患者纳入研究，平均年龄49岁。大多数患者在即刻情况下进行双侧重建（65%，n = 77），其中70%（n = 83）为即刻重建。56%的患者在CTA上有偶发发现，最常见的是肝脏（20%）、肾脏（14%）和骨骼（11%）异常。19例（16%）患者被建议进行包括超声、CT和磁共振成像在内的额外影像学检查。3例患者在重建前进行了额外会诊（分别怀疑有骨转移、腹内肿块和结肠恶性肿瘤）。未发现因CT检查结果导致明显的手术延迟。
腹部/盆腔术前CTA后发现偶发瘤很常见（56%）。然而，与之前的报告不同，我们未观察到发现偶发瘤后重建计划有改变。我们建议在进行CTA前向所有患者告知发现偶发瘤的可能性以及进行额外影像学检查的必要性。
