Abstract
High-resolution neuroimaging modalities are used often in studies involving healthy volunteers. Subsequently, a significant increase in the incidental discovery of asymptomatic intracranial abnormalities raised the important ethical issues of when follow-up and treatment may be necessary. We examined the literature to establish a practical set of criteria for approaching incidental findings. Our objective is to develop an algorithm for when follow-up may be important and to provide recommendations that would increase the likelihood of follow-up. A systematic literature search was performed using the PubMed and MEDLINE databases to identify articles describing brain tumors and intracranial aneurysms. The treatment algorithm we present suggests that incidental intracranial masses suspicious for glioma should be biopsied or resected, while other masses are to be followed with serial imaging based on the expected growth pattern. Lack of follow-up can result in adverse outcomes that can be mitigated by using technology to facilitate communication and improve follow-up care. The importance of training physicians to be good communicators is also stressed. New technology including automated telephone systems, texting and email will improve access to patients and hopefully encourage compliance and follow-up.
Similar content being viewed by others
References
Bartlett, E. E., Grayson, M., Barker, R., Levine, D. M., Golden, A., & Libber, S. (1984). The effects of physician communications skills on patient satisfaction, recall, and adherence. Journal of Chronic Diseases, 37(9–10), 755–764.
Barker, C. S. (1992). Peripheral cerebral aneurysm associated with a glioma. Neuroradiology, 34, 30–32.
Bender, B. G., Apter, A., Bogen, D. K., Dickinson, P., Fisher, L., Wamboldt, F. S., et al. (2010). Test of an interactive voice response intervention to improve adherence to controller medications in adults with asthma. Journal of the American Board of Family Medicine, 23, 159–165.
Cramer, S. C., Wu, J., Hanson, J. A., Nouri, S., Karnani, D., Chuang, T. M., et al. (2011). A system for addressing incidental findings in neuroimaging research. Neuroimage, 55, 1020–1023.
DiMatteo, M. R. (2004). Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Medical Care, 42, 200–209.
Duffau, H., Pallud, J., & Mandonnet, E. (2011). Evidence for the genesis of WHO grade II glioma in an asymptomatic young adult using repeated MRIs. Acta Neurochirurgica (Wien), 153, 473–477.
Fernancez-Balsells, M. M., Murad, M. H., Barwise, A., Gallegos-Orozco, J. F., Paul, A., Lane, M. A., et al. (2011). Natural history of nonfunctioning pituitary adenomas and incidentalomas: A systematic review and metaanalysis. Journal of Clinical Endocrinology and Metabolism, 96, 905–912.
Hashiba, T., Hashimoto, N., Izumoto, S., Suzuki, T., Kagawa, N., Maruno, M., et al. (2009). Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. Journal of Neurosurgery, 110, 675–684.
Igarashi, T., Saeki, N., & Yamaura, A. (1999). Long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors: Their natural history and surgical indications. Neurologia Medico-Chirurgica (Tokyo), 39, 592–599.
Illes, J., & Chin, V. (2008). Bridging philosophical and practical implications of incidental findings in brain research. Journal of Law, Medicine and Ethics, 2, 298–312.
Illes, J., Kirschen, M. P., Edwards, E., Stanford, L. R., Bandettini, P., Cho, M. K., et al. (2006). Ethics. Incidental findings in brain imaging research. Science, 311, 783–784.
Illes, J., Kirschen, M. P., Karetsky, K., Kelly, M., Saha, A., Desmond, J. E., et al. (2004). Discovery and disclosure of incidental findings in neuroimaging. Journal of Magnetic Resonance Imaging, 20, 743–747.
Kamiguchi, H., Shiobara, R., & Toya, S. (1996). Accidentally detected brain tumors: clinical analysis of a series of 110 patients. Clinical Neurology and Neurosurgery, 98, 171–175.
Kasuya, H., Kubo, O., Tanaka, M., Amano, K., Kato, K., & Hori, T. (2006). Clinical and radiological features related to the growth potential of meningioma. Neurosurgical Review, 29, 293–297.
Katzman, G. L., Dagher, A. P., & Patronas, N. J. (1999). Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. Journal of the American Medical Association, 282, 36–39.
Kripalani, S., & Weiss, B. D. (2006). Teaching about health literacy and clear communication. Journal of General Internal Medicine, 21(8), 888–890.
Kuratsu, J., Kochi, M., & Ushio, Y. (2000). Incidence and clinical features of asymptomatic meningiomas. Journal of Neurosurgery, 92, 766–770.
Leffler, D. A., Neeman, N., Rabb, J. M., Shin, J. Y., Landon, B. E., Pallav, K., et al. (2011). An alerting system improves adherence to follow-up recommendations from colonoscopy examinations. Gastroenterology, 140, 1166–1173.
Manara, R., Maffei, P., Citton, V., Rizzati, S., Bommarito, G., Ermani, M., et al. (2011). Increased Rate of Intracranial Saccular Aneurysms in Acromegaly: An MR Angiography Study and Review of the Literature. Journal of Clinical Endocrinology and Metabolism, 96, 1292–1300.
Moore, C., McGinn, T., & Halm, E. (2007). Tying up loose ends: Discharging patients with unresolved medical issues. Archives of Internal Medicine, 167, 1305–1311.
Morris, Z., Whiteley, W. N., Longstreth, W. T., Weber, F., Lee, Y.-C., Tsushima, Y., et al. (2009). Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. British Medical Journal, 339, b3016.
Onizuka, M., Suyama, K., Shibayama, A., Hiura, T., Horie, N., & Miyazaki, H. (2001). Asymptomatic brain tumor detected at brain check-up. Neurologia Medico-Chirurgica (Tokyo), 41, 431–434.
Oya, S., Kim, S. H., Sade, B., & Lee, J. H. (2011). The natural history of intracranial meningiomas. Journal of Neurosurgery, 114, 1250–1256.
Pallud, J., Fontaine, D., Duffau, H., Mandonnet, E., Sanai, N., Taillandier, L., et al. (2010). Natural history of incidental World Health Organization grade II gliomas. Annals of Neurology, 68, 727–733.
Perks, A., Chakravarti, S., & Manninen, P. (2009). Preoperative anxiety in neurosurgical patients. Journal of Neurosurgical Anesthesiology, 21(2), 127–130.
Piette, J. D., Kramer, F. B., Weinberger, M., et al. (2001). Impact of Automated calls with nurse follow-up in a diabetes treatment outcomes in a department of veterans affairs health care system. Diabetes Care, 24, 202–208.
Pop-Eleches, Thirumurthy, H., Habyarimana, J. P., et al. (2011). Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. Acquired Immune Deficiency Syndrome, 25, 825–834.
Roter, D. L., Hall, J. A., Kern, D. E., et al. (1995). Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Archives of Internal Medicine, 155(17), 1877–1884.
Seki, A., Uchiyama, H., Fukushi, T., et al. (2010). Incidental findings of brain magnetic resonance imaging study in a pediatric cohort in Japan and recommendation for a model management protocol. Journal of Epidemiology, 20, S498–S504.
Schmitt, P. J., & Prestigiacomo, C. J. (2011). Readability of neurosurgery-related patient education materials provided by the american association of neurological surgeons and the national library of medicine and national institutes of health. World Neurosurgery (Epub ahead of print).
Steiger, H. J. (2006). Preventive neurosurgery: population-wide check-up examinations and correction of asymptomatic pathologies of the nervous system. Acta Neurochirurgica (Wien), 148, 1075–1083.
Vernooij, M. W., Ikram, M., Tanghe, H. L., Vincent, A. J. P. E., Hofman, A., Krestin, G. P., et al. (2007). Incidental findings on brain MRI in the general population. New England Journal of Medicine, 357, 1821–1828.
Weber, F., & Knopf, H. (2006). Incidental findings in magnetic resonance imaging of the brains of healthy young men. Journal of the Neurological Sciences, 240, 81–84.
Yano, S., Kuratsu, J., & the Kumamoto Brain Tumor Research Group. (2008). Indications for Surgery in patients with asymptomatic meningiomas based on an extensive experience. Journal of Neurosurgery, 105, 538–543.
Zolnierek, K. B., & Dimatteo, M. R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical Care, 47, 826–834.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Drazin, D., Spitler, K., Cekic, M. et al. Incidental Finding of Tumor While Investigating Subarachnoid Hemorrhage: Ethical Considerations and Practical Strategies. Sci Eng Ethics 19, 1107–1120 (2013). https://doi.org/10.1007/s11948-012-9403-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11948-012-9403-6