Abstract
Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.
Highlights
The challenge of managing incidental findings (IFs) in clinical practice and research is growing with the increasing accessibility of powerful imaging modalities such as Magnetic resonance imaging (MRI) [1,2,3]
All analyses are based on data from the Study of Health in Pomerania (SHIP)-2 and SHIPTrend-0 examinations, which were conducted in parallel and included among others extensive laboratory investigations, a personal interview about medical history, socio-demographics, and a whole-body MRI
The descriptive characteristics of participants (N = 6753) are summarized in Table 1 stratified by cohort and MRI participation
Summary
The challenge of managing incidental findings (IFs) in clinical practice and research is growing with the increasing accessibility of powerful imaging modalities such as MRI [1,2,3]. Extended author information available on the last page of the article a population-based cohort of 2500 participants resulted in 13,455 IFs, of which 1330 were potentially clinically relevant and disclosed to participants [1]. Between 50 and 80% of IFs from research MRI are suspicious for malignancy [1, 3]. Such findings may enable timely treatment of a disease, offering potential improvement or preservation of quality and length of life [5, 6]. On the other hand, overtesting and overdiagnosis may result [7], incurring additional costs to the health care system as well as psychosocial costs for patients who anxiously await results or are faced with findings of unknown relevance [8, 9]
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