INCIDENTALOMAS
Once incidentalomas are detected, appropriate management is dependent on an informed patient's wishes and the clinical situation.
• Patients presenting with pituitary incidentalomas should undergo pituitary-specific magnetic resonance imaging if the lesion is 1 cm or larger, or if it abuts the optic chiasm.
• Thyroid incidentalomas are ubiquitous, but nodules larger than 1 to 2 cm are of greater concern.
• Worrisome pulmonary incidentalomas are those larger than 8 mm or those with irregular borders, eccentric calcifications, or low density. However, current guidelines recommend that even pulmonary incidentalomas as small as 4 mm be followed.
• Solid hepatic incidentalomas 5 mm or larger should be monitored closely, and multiphasic scanning is helpful.
• Pancreatic cystic neoplasms have malignant potential, and surgery is recommended for pancreatic cysts larger than 3 cm with suspicious features.
• Adrenal lesions larger than 4 cm are usually biopsied.
• The Bosniak classification is a well-accepted means of triaging renal incidentalomas. Lesions at category IIF or greater require serial monitoring or surgery.
• Benign or probably benign ovarian cysts 3 cm or smaller in premenopausal women or 1 cm or smaller in postmenopausal women do not require follow-up. Ovarian cysts with thickened walls or septa, or solid components with blood flow, should be managed closely.
Satyendra Dhar MD,
