Incidental findings in a referral pathway for non-specific cancer symptoms

Rationale and objectives: To determine the prevalence of incidental findings and define the rate and outcomes of further investigations in a referral pathway for patients with non-specific cancer symptoms.

Material and methods: Incidental findings in each category of a structured report were documented and details of subsequent investigations were obtained from the local PACS and Electronic Patient Record system.

Results: 1034 patients were included. Of these, 11% were diagnosed with cancer. The majority of patients (95%) had at least one additional finding reported. The majority of these were minor, but in 140 cases (14%), additional findings were considered to be of clinical significance. Further investigations were performed in 330 patients who did not receive a diagnosis of cancer (32%). In 301 patients (29%), further investigations were normal or non-significant. In 75 cases (7%), ongoing surveillance was required. Specialist referral was recommended for 102 patients (10%) who did not receive a diagnosis of cancer.

Conclusions: In this cohort, there was a high rate of non-significant incidental findings and normal further investigations. However, these risks are likely to be outweighed by the high number of cancer diagnoses and significant non-cancer findings.