Department of Medicine, Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Surgery, Boston Medical Center, Boston, Massachusetts.
J Am Coll Radiol. 2021 Apr;18(4):566-579. doi: 10.1016/j.jacr.2020.11.006. Epub 2020 Dec 2.
Incidentalomas, or unexpectedly identified masses, are frequently identified in diagnostic imaging studies. Incidentalomas may require timely follow-up care to determine if they are benign, disease-causing, or malignant lesions; however, many incidentalomas do not receive diagnostic workup. The most effective strategies to manage incidentalomas and optimal metrics for judging the efficacy of these strategies remain unclear.
To identify management strategies used to promote guideline-concordant follow-up for incidentalomas and commonly reported performance metrics associated with these strategies.
We searched peer-reviewed literature for incidentaloma management studies published between 2003 and 2020.
Data extraction included anatomical location, imaging modality, clinical setting, management strategy characteristics, and metrics used to assess the management strategy. Eligible studies were analyzed qualitatively to describe strategies and metrics.
In all, 15 studies met inclusion criteria. Four types of interventions designed to promote guideline-concordant follow-up care for incidentalomas were identified: (1) physical or verbal guideline reminders (n = 3); (2) electronic guideline references (n = 4); (3) enhanced radiology templates (n = 3); (4) restructured clinical and communication pathways (n = 5). Strategy efficacy was assessed by measuring rates of patients who received recommended follow-up care (n = 6) or had care recommendations documented in clinical records (n = 5). Few studies measured diagnostic outcomes associated with incidentalomas.
Most management strategies target changes in radiologists' behavior. Few studies address barriers to improving incidentaloma follow-up from interpretation to patient education of findings and care delivery. Hybrid effectiveness-implementation studies are needed to better address workflow barriers and rigorously evaluate care delivery outcomes.
偶然发现的病变，即意外发现的肿块，在诊断性影像学研究中经常被发现。偶然发现的病变可能需要及时进行后续护理，以确定其是良性、致病还是恶性病变；然而，许多偶然发现的病变没有进行诊断性检查。管理偶然发现的病变的最有效策略以及判断这些策略效果的最佳指标仍不清楚。
确定用于促进偶然发现的病变遵循指南的管理策略以及与这些策略相关的常用报告指标。
我们搜索了 2003 年至 2020 年期间发表的关于偶然发现的病变管理研究的同行评议文献。
数据提取包括解剖部位、成像方式、临床环境、管理策略特征以及用于评估管理策略的指标。合格的研究进行了定性分析，以描述策略和指标。
共有 15 项研究符合纳入标准。确定了四种旨在促进偶然发现的病变遵循指南的后续护理的干预措施：（1）物理或口头指南提醒（n=3）；（2）电子指南参考（n=4）；（3）增强的放射学模板（n=3）；（4）重组临床和沟通途径（n=5）。通过测量接受推荐的后续护理的患者比例（n=6）或在临床记录中记录护理建议的患者比例（n=5）来评估策略的效果。很少有研究测量与偶然发现的病变相关的诊断结果。
大多数管理策略针对放射科医生行为的改变。很少有研究解决从解释到发现患者教育和护理提供的改善偶然发现的病变后续护理的障碍。需要进行混合有效性实施研究，以更好地解决工作流程障碍，并严格评估护理提供结果。
