At NYBRA/Aesthetic Plastic Surgery, PC, as well as in many other practices, CT angiography (CTA) of the abdomen is a common preoperative imaging study performed prior to breast reconstruction with abdominal tissue, like a TRAM or DIEP flap. CTAs can accurately detect blood vessel anatomy, aid in surgical planning, and decrease operative time.
However, incidental findings on CTAs, so-called “incidentalomas,” are not uncommon and can have an impact on patient management as well as patient anxiety, particularly those patients with a known genetic mutation who might expect to find a higher rate of clinically significant findings on imaging. Seeking answers for their patients, they studied the ultimate impact of these incidental findings on the surgical plan for our free flap reconstruction patients.
This past January, Dr. Jonathan Bank presented the results of his and Dr. Ron Israeli's recent research project at the annual meeting of the American Society of Reconstructive Microsurgery in Hawaii. The purpose of the study was two-fold: to present the largest series of CTAs reviewed for "incidentalomas," and to compare the rates between breast cancer patients with, and without, genetic mutations. Dr. Bank was pleased to report positive findings from the research which shows, regardless of mutation status, that "incidentalomas" are most commonly benign with minimal impact on their surgical plan.
In summary, the overall rate of any CTA incidentaloma in these 496 patients was 71%. Only 2.8% required an intervention of any kind, with the management plan of only two patients affected. Contrary to their hypothesis, incidentalomas and pathological findings were no more common among patients known to be carriers of genetic mutations.
They concluded that patients undergoing pre-operative CTAs should be counseled regarding the high likelihood of incidental findings but reassured, regardless of mutation status, that "incidentalomas" are most commonly benign with minimal impact on their surgical plan.
*photo courtesy of RadiologyInfo.org