Yep. Ditzels are a thing!! Incidentals found during routine radiologic studies. I've found gall stones, sparkly doo dads in my thyroid, and uterine fibroids...all of which were doing me NO HARM...in the process of years of scans and surveys to follow my melanoma. Alternatively, a routine chest x-ray in 2010 (of all simple things) revealed a lesion within the right main bronchus of my lung that no one could believe was melanoma for months - until it was finally biopsied via a bronchoscopy. Then there's the funny looking, "probably mucoid", appendix that showed up on my final melanoma scans in August that turned out to be ex-goblet cell carcinoma (GCC)!!!! And I am not alone...
False-Positive Results and Incidental Findings with Annual CT or PET/CT Surveillance in Asymptomatic Patients with Resected Stage III Melanoma. Nijhuis, Dieng, Khanna, et al. Ann Surg Oncol. 2019 Mar 25.
The aim of this study was to quantify false-positive and incidental findings from annual surveillance imaging in asymptomatic, American Joint Committee on Cancer stage III melanoma patients.
This was a cohort study of patients treated at Melanoma Institute Australia (2000-2015) with baseline computed tomography (CT) or positron emission tomography (PET)/CT imaging and at least two annual surveillance scans. False-positives were defined as findings suspicious for melanoma recurrence that were not melanoma, confirmed by histopathology, subsequent imaging, or clinical follow-up, while incidental findings were defined as non-melanoma-related findings requiring further action. Outcomes of incidental findings were classified as 'benign' if they resolved spontaneously or were not seriously harmful; 'malignant' if a second malignancy was identified; or 'other' if potentially harmful.
Among 154 patients, 1022 scans were performed (154 baseline staging, 868 surveillance) during a median follow-up of 85 months; 57 patients (37%) developed a recurrence. For baseline and surveillance imaging, 124 false-positive results and incidental findings were identified in 81 patients (53%). The frequency of these findings was 5-14% per year, and an additional 181 tests, procedures, and referrals were initiated to investigate these findings. The diagnosis was benign in 109 findings of 124 findings (88%). Fifteen patients with a benign finding underwent an unnecessary invasive procedure. Surveillance imaging identified distant metastases in 20 patients (13%).
False-positive results and incidental findings occur in at least half of all patients undergoing annual surveillance imaging, and the additional healthcare use is substantial. These findings persist over time. Clinicians need to be aware of these risks and discuss them with patients, alongside the expected benefits of surveillance imaging.
So, yeah. Right now, with imaging being the preferred method of follow-up for melanoma peeps, at least half of us will experience findings that will have to be investigated (to some extent) that will NOT be melanoma! DO NOT FREAK OUT!!! Unfortunately, this is to be expected. Still, we must be diligent and pursue needed answers when weird things show up. All the more reason for putting blood assays that test for melanoma specifically and tangentially into practice sooner rather than later!!! Here's the latest on that front (with a zillion links within) posted just last month: Circulating tumor DNA (ctDNA)
Hang tough melanoma peeps! Ours is not an easy path. But, it is one that we can not only walk down, but run through!!! - c
No comments:
Post a Comment