Follow-up imaging unnecessary for incidental splenic mass findings

While patients who demonstrate an incidental splenic mass during CT scans may not also indicate the appearance of a simple cyst, researchers determined additional imaging is not warranted, and further work-up only required depending on a patient’s medical history.

Incidental masses in the abdomen area are quite common, notes a study published online Jan. 23 in Radiology. In fact, they are reportedly found in 35 to 56 percent of trauma patients who have undergone a CT scan.

Most solid splenic masses are benign, but CT imaging characteristics of benign and malignant splenic masses often overlap.

Current recommendations derived from a 2013 American College of Radiology white paper call for follow-up for all non-cystic splenic masses larger than one centimeter that do not have clearly benign features upon imaging detection.

Researchers from Beth Israel Deaconess Medical Center in Boston, however, disagree. Corresponding author of the study, Bettina Siewert, MD at Beth Israel writes, “Such a practice would increase health care costs and potentially expose patients to increased morbidity and mortality.”

The researchers examined CT scans in 379 patients with splenic masses at CT exams of the abdomen and chest from 2002 to 2008. The retrospective study divided patients into three groups:

Group 1: 145 patients with a history of malignancy.

Group 2: 29 patients with symptoms such as weight loss, fever or pain related to the left upper quadrant and epigastrium.

Group 3: 205 patients with incidental findings.

Results showed the incidence of malignant splenic masses was 33.8 percent in the malignancy group, 27.6 percent in the symptomatic group and 1 percent in the incidental group. The incidental group consisted of new diagnoses of lymphoma in one patient and metastases from ovarian carcinoma in one patient.

“Additional imaging or follow-up is not warranted, even if the mass does not show the appearance of a simple cyst. Further work-up is only needed if the splenic mass is seen in conjunction with other findings worrisome for malignancy,” wrote Siewert and colleagues.

Authors note that although findings do not suggest a need for further imaging, having access to patient history through a comprehensive electronic health record is integral in this decision, which may be challenging for providers.

“The implementation of our follow-up recommendations will require diligence by the radiologist to carefully review a patient’s electronic medical record for a history of malignancy to ensure that such history was not omitted from the indication for the examination,” Siewert et al. added.