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Impact of detecting potentially serious incidental findings during multi-modal imaging.
Gibson, Lorna M; Littlejohns, Thomas J; Adamska, Ligia; Garratt, Steve; Doherty, Nicola; Wardlaw, Joanna M; Maskell, Giles; Parker, Michael; Brownsword, Roger; Matthews, Paul M; Collins, Rory; Allen, Naomi E; Sellors, Jonathan; Sudlow, Cathie Lm.
Afiliação
  • Gibson LM; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
  • Littlejohns TJ; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Adamska L; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Garratt S; UK Biobank Coordinating Centre, Stockport, UK.
  • Doherty N; UK Biobank Coordinating Centre, Stockport, UK.
  • Wardlaw JM; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
  • Maskell G; Royal Cornwall Hospitals NHS Trust, Cornwall, UK.
  • Parker M; Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Brownsword R; The Dickson Poon School of Law, King's College London, London, UK.
  • Matthews PM; UK Biobank Coordinating Centre, Stockport, UK.
  • Collins R; Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK.
  • Allen NE; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Sellors J; UK Biobank Coordinating Centre, Stockport, UK.
  • Sudlow CL; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Wellcome Open Res ; 2: 114, 2017.
Article em En | MEDLINE | ID: mdl-30009267
ABSTRACT

Background:

 There are limited data on the impact of feedback of incidental findings (IFs) from research imaging.  We evaluated the impact of UK Biobank's protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer 'flagging' with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images.

Methods:

 Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts.

Results:

 Compared to systematic radiologist review, radiographer flagging resulted in substantially fewer participants with potentially serious IFs (179/1000 [17.9%] versus 18/1000 [1.8%]) and a higher proportion with serious final diagnoses (21/179 [11.7%] versus 5/18 [27.8%]). Radiographer flagging missed 16/21 serious final diagnoses (i.e., false negatives), while systematic radiologist review generated large numbers of non-serious final diagnoses (158/179) (i.e., false positives). Almost all (90%) participants had further clinical assessment (including invasive procedures in similar numbers with serious and non-serious final diagnoses [11 and 12 respectively]), with additional impact on emotional wellbeing (16.9%), finances (8.9%), and work or activities (5.6%).

Conclusions:

 Compared with systematic radiologist review, radiographer flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank's responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2017 Tipo de documento: Article