Abstract
ObjectiveTo determine the frequency and factors associated with incidental imaging findings (incidentalomas) that are referred to a specialized sarcoma center and that eventually turn out to be benign or of low-risk malignant potential, and to assess their downstream healthcare costs. Materials and methodsThis study included all consecutive new patients that were referred to a specialized sarcoma center within a 7-month period. ResultsOf 221 patients that were included, 28 had an incidentaloma. Of these 28 incidentalomas, 23 were benign (n = 11) or of low-risk malignant potential (n = 12), corresponding to a frequency of 10.4% Utilization of conventional radiography (odds ratio [OR] = 6.538, P = 0.018) and CT (OR = 8.167, P = 0.012) was significantly more associated with the detection of benign or low-risk malignant potential incidentalomas than ultrasonography. The likelihood of detecting benign or low-risk malignant potential incidentalomas after MRI utilization was not significantly different from that after ultrasonography (P = 0.174). All other variables (including patient age and gender, history of malignancy, specialty by whom the lesion was initially detected, and lesion location) were not significantly associated with these incidentalomas. The 23 cases with an incidentaloma that turned out to be benign or of low-risk malignant potential resulted in a total of €42,707 ($49,552) downstream healthcare costs, with an average of €1857 ($2155) per case. ConclusionIncidentalomas that are referred to a specialized sarcoma center and that eventually prove to be benign or of low-risk malignant potential are common, are more frequently detected on conventional radiographs and CT, and cause relevant subsequent healthcare costs.
Highlights
Sarcomas are a diverse group of cancers of mesenchymal origin.[1]
The purpose of this study was to determine the frequency and factors associated with incidentalomas that are referred to a specialized sarcoma center and that eventually turn out to be benign or of low-risk malignant potential, and to assess their downstream healthcare costs
The results of this study show that incidentalomas that eventually prove to be benign or of low-risk malignant potential comprise a considerable proportion of cases (1 out of 10) that are referred to a specialized sarcoma center
Summary
Sarcomas are a diverse group of cancers of mesenchymal origin.[1]. The vast majority of sarcomas are soft tissue sarcomas, while malignant bone tumors comprise just over 10% of sarcomas.[2]. With most occurring in fewer than 5 per 1,000,000.3 Survival is poorer for those with more advanced grade, stage, and age at diagnosis.[3]. The diagnosis of sarcoma may be suspected based on clinical grounds and/or medical imaging findings. Once a sarcoma is suspected, patients are usually referred to a specialized sarcoma center, because early diagnosis and prompt (multimodality) treatment in a specialized sar coma center are considered essential to improve patient outcome.[4]. Not all patients who are referred to a specialized sarcoma center are eventually diagnosed with this disease. Alternative diagnoses include other malignancies than sarcoma, benign lesions, and biologi cally indeterminate lesions with low-risk malignant potential
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