From the Division of Plastic Surgery and the Department of Radiology, Lenox Hill Hospital at Northwell Health; the Department of Surgery, Beaumont Health; and New York Breast Reconstruction Associates.
Plast Reconstr Surg. 2021 Jun 1;147(6):1259-1269. doi: 10.1097/PRS.0000000000007941.
Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram "incidentalomas" in these two populations and an evidence-based algorithm for managing common findings.
All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management.
Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy-renal cell carcinoma-which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas.
The authors' rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.
游离皮瓣乳房重建术的术前腹部 CT 血管造影可提高手术安全性和效率，但偶然发现很常见，并且可能会影响处理方式。此外，作者假设具有基因突变的患者可能具有更高的显著发现率。作者提出了这两个群体中最大的 CT 血管造影“偶发瘤”系列以及管理常见发现的循证算法。
符合条件的患者为 2009 年至 2017 年在 Northwell Health 接受游离皮瓣乳房重建术的所有患者。检查了病史，围手术期细节和放射学报告，并记录了异常发现。对放射科医生进行了文献综述，以制定偶发瘤管理的标准化指南。
在 805 例患者中，有 733 例患者进行了腹部影像学检查。195 例（27％）的检查完全为阴性。在其余 538 例患者中，最常见的良性肝（22％）和肾（17％）发现。有 16 例患者（2.2％）需要进一步进行影像学检查（n = 15）或进行手术（n = 5）。有一个发现令人担忧为恶性肿瘤-肾细胞癌-介入放射科在术后对其进行了消融。有 79 例（10.8％）患者有基因突变，但并未发现偶发瘤的发生率有统计学意义上的增加。
作者的 CT 血管造影偶然发现率（73％）与先前的研究一致，但需要进一步干预的发生率（2.2％）较低。基因突变携带者的偶然发现并不更常见或更具病理性。作者还提出了一种管理常见偶发瘤的循证算法。使用这些指南，无论突变状态如何，整形外科医生都可以使患者放心，因为偶发瘤大多数为良性，对其手术计划的影响最小。
