The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign
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The effects of incidental findings from whole‑body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study Adrian Richter1 · Elizabeth Sierocinski1,2 · Stephan Singer3,4 · Robin Bülow5 · Carolin Hackmann1,6 · Jean‑François Chenot2 · Carsten Oliver Schmidt1 Received: 3 April 2020 / Accepted: 19 August 2020 © The Author(s) 2020
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. Keywords Magnetic resonance imaging · Incidental findings · Biopsies · Histological examinations · Record linkage
Introduction 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 [1–3]. IFs frequently occur in clinical as well as in research settings [1, 2, 4]. The use of whole-body MRI (wb-MRI) in Adrian Richter and Elizabeth Sierocinski have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10654-020-00679-4) contains supplementary material, which is available to authorized users. * Adrian Richter adrian.richter@uni‑greifswald.de Extended author information available on the last page of the article
a population-based cohort of 2500 parti
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