Background
DIEP flaps are frequently used to reconstruct a breast following mastectomy, and an abdominal wall CT angiogram is often used to assess the perforating arterial supply to the flap. Incidental findings on CT scans are a common phenomenon, and a frequent cause of anxiety to patients, as well as a use of resources to further investigate and treat these. We noted that our patients commonly demonstrate these incidental findings on planning CT angiography, which often need to be investigated prior to the DIEP surgery.
Method
All patients referred to the department for consideration of breast reconstruction between January 2013 and June 2018 were identified. 749 records were assessed, with 210 patients having undergone CT scanning.
Results
Incidental findings were seen on 136 of these scans (65%). Of these, 107 (78%) required no further follow up, either due to known pathology or benign findings. The most common site of incidental findings was in the liver (34%), followed by gynaecological (23%), then bone (19%), renal (17%) and lung (14%).
26 (12.4% of all patients) required further investigation or management. 29 further imaging tests were performed, with 10 referrals to other specialties. 1 patient had an acute admission and 3 underwent operations unrelated to their breast cancer diagnosis. 2 patients had a delay to their mastectomy whilst investigations were performed, and 1 had a delay to reconstruction. There was 1 confirmed case of a metastatic cancer diagnosis and 1 possible case.
Conclusion
Not only are incidental findings common, over 1 in 10 planning CT scans will demonstrate clinically significant findings and women should be counselled as such. Although most incidental findings are benign, plastic surgeons should always be aware that planning CT scans may rarely show the first sign of a metastatic cancer, and these results should be followed up promptly.