The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study

Abstract Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.

Download Full-text

Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany

BMJ Open ◽

10.1136/bmjopen-2021-056572 ◽

2022 ◽

Vol 12 (1) ◽

pp. e056572

Author(s):

Carsten Oliver Schmidt ◽

Elizabeth Sierocinski ◽

Sebastian Baumeister ◽

Katrin Hegenscheid ◽

Henry Völzke ◽

...

Keyword(s):

Cohort Study ◽

General Population ◽

Health Service ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Population Based ◽

Whole Body ◽

Service Utilisation ◽

Specialist Care ◽

Whole Body Mri

ObjectiveWhole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are particularly critical in an observational study. Our principal research question was therefore how participation in a wb-MRI examination with its resemblance to a population-based health screening is associated with outpatient service costs.DesignProspective cohort study.SettingGeneral population Mecklenburg-Vorpommern, Germany.ParticipantsAnalyses included 5019 participants of the Study of Health in Pomerania with statutory health insurance data. 2969 took part in a wb-MRI examination in addition to a clinical examination programme that was administered to all participants. MRI non-participants served as a quasi-experimental control group with propensity score weighting to account for baseline differences.Primary and secondary outcome measuresOutpatient costs (total healthcare usage, primary care, specialist care, laboratory tests, imaging) during 24 months after the examination were retrieved from claims data. Two-part models were used to compute treatment effects.ResultsIn total, 1366 potentially relevant IFs were disclosed to 948 MRI participants (32% of all participants); most concerned masses and lesions (769 participants, 81%). Costs for outpatient care during the 2-year observation period amounted to an average of €2547 (95% CI 2424 to 2671) for MRI non-participants and to €2839 (95% CI 2741 to 2936) for MRI participants, indicating an increase of €295 (95% CI 134 to 456) per participant which corresponds to 11.6% (95% CI 5.2% to 17.9%). The cost increase was sustained rather than being a short-term spike. Imaging and specialist care related costs were the main contributors to the increase in costs.ConclusionsCommunicated findings from population-based wb-MRI substantially impacted health service utilisation and costs. This introduced bias into the natural course of healthcare utilisation and should be taken care for in any longitudinal analyses.

Download Full-text

Incidental findings in whole-body MR imaging of a population-based cohort study: Frequency, management and psychosocial consequences

European Journal of Radiology ◽

10.1016/j.ejrad.2020.109451 ◽

2021 ◽

Vol 134 ◽

pp. 109451

Author(s):

Christopher L. Schlett ◽

Susanne Rospleszcz ◽

Dorina Korbmacher ◽

Roberto Lorbeer ◽

Sigrid Auweter ◽

...

Keyword(s):

Cohort Study ◽

Mr Imaging ◽

Incidental Findings ◽

Population Based ◽

Whole Body ◽

Psychosocial Consequences ◽

Frequency Management

Download Full-text

Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-212824 ◽

2020 ◽

pp. jech-2019-212824

Author(s):

Katharina Piontek ◽

Adrian Richter ◽

Katrin Hegenscheid ◽

Jean-Francois Chenot ◽

Carsten Oliver Schmidt

Keyword(s):

Predictive Value ◽

False Positive ◽

Incidental Findings ◽

False Negative ◽

Population Based ◽

Whole Body ◽

Population Based Study ◽

Recall Accuracy ◽

Whole Body Mri ◽

Self Reports

BackgroundSelf-reports of medical findings are indispensable in clinical practice and research but subject to recall bias. We analysed the recall accuracy of notifications about incidental findings (IFs) from a whole-body MRI examination and assessed determinants of recall error.MethodsData from 3746 participants of a postal follow-up survey conducted on average 2.47 years after examination in the population-based Study of Health in Pomerania were analysed. Among those, 2185 (58.3%) underwent whole-body MRI at baseline, and findings of potential clinical relevance were disclosed in standardised postal letters. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to determine the accuracy of self-reports. Poisson regression analysis was conducted to analyse predictors for false-positive and false-negative recall.ResultsAn IF was disclosed to 622 (28.5%) individuals; 81.5% had tumour relevance. The overall sensitivity and PPV of participants’ self-reports were 80% and 60%, respectively. PPvs were higher among women, better educated and married participants and among those with good verbal memory. Among MRI participants, lower educational level was associated with a higher risk of false-positive recall (risk ratio (RR) 1.44, 95% CI 1.01 to 2.03), while increasing age was associated with a higher risk of false-negative recall (RR 1.64, 95% CI 1.33 to 2.01).ConclusionsMost participants correctly recalled disclosed IFs. However, the probability of an event in case of a positive recall is barely above 50%. Therefore, relying on subjects’ recall of disclosed IFs will lead to a relevant proportion of errors. Clinicians and researchers should be aware of this problem and of participants’ characteristics which may moderate the probability of correct decisions based on recalled findings.

Download Full-text

Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management

European Radiology ◽

10.1007/s00330-012-2636-6 ◽

2012 ◽

Vol 23 (3) ◽

pp. 816-826 ◽

Cited By ~ 67

Author(s):

Katrin Hegenscheid ◽

Rebecca Seipel ◽

Carsten O. Schmidt ◽

Henry Völzke ◽

Jens-Peter Kühn ◽

...

Keyword(s):

Incidental Findings ◽

Adult Population ◽

Whole Body ◽

Whole Body Mri ◽

General Adult Population

Download Full-text

Incidence of chronic immune-mediated inflammatory diseases after diagnosis with Kawasaki disease: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keab680 ◽

2021 ◽

Author(s):

Stephen G Fung ◽

Richard Webster ◽

M Ellen Kuenzig ◽

Braden D Knight ◽

Michelle Batthish ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Liver Disease ◽

Kawasaki Disease ◽

Sclerosing Cholangitis ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Population Based ◽

Immune Mediated ◽

Increased Risk

Abstract Objectives Kawasaki disease (KD) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis and multiple sclerosis. Methods We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991 and 2016 diagnosed with KD (n = 3753) were matched to 5 non-KD controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of KD. Three- and 12-month washout periods were used to exclude KD-related symptoms. Results There was an elevated risk of arthritis in KD patients compared with non-KD controls, starting 3 months after index date [103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio 8.07 (95% CI 4.95, 13.2); hazard ratio 8.08 (95% CI 4.95, 13.2), resulting in the overall incidence of IMIDs being elevated in KD patients (175.1 vs 68.0 per 100 000 PYs; incidence rate ratio 2.58 (95% CI 1.93, 3.43); hazard ratio 2.58, 95% CI 1.94, 3.43]. However, there was no increased risk for diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis or multiple sclerosis in KD patients. Similar results were observed using a 12-month washout period. Conclusion Children diagnosed with KD were at increased risk of arthritis following the acute KD event, but not other IMIDs. Health-care providers should monitor for arthritis in children following a diagnosis of KD.

Download Full-text

Prostate cancer and occupational exposure to whole-body vibration in a national population-based cohort study

American Journal of Industrial Medicine ◽

10.1002/ajim.22354 ◽

2014 ◽

Vol 57 (8) ◽

pp. 896-905 ◽

Cited By ~ 6

Author(s):

Marcella K. Jones ◽

M. Anne Harris ◽

Paul A. Peters ◽

Michael Tjepkema ◽

Paul A. Demers

Keyword(s):

Prostate Cancer ◽

Cohort Study ◽

Occupational Exposure ◽

Whole Body Vibration ◽

Population Based ◽

Whole Body ◽

Body Vibration ◽

National Population

Download Full-text

Public housing and healthcare use: Determining whether public housing functions as an intervention using linked population-based administrative data

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.803 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Aynslie Hinds ◽

Brian Bechtel ◽

Jino Distasio ◽

Leslie Roos ◽

Lisa Lix

Keyword(s):

General Population ◽

Public Housing ◽

Rate Ratio ◽

Linear Models ◽

Negative Binomial ◽

Positive Impact ◽

Population Group ◽

Healthcare Services ◽

Population Based ◽

Healthcare Use

IntroductionPublic housing is a form of subsidized housing that is owned and/or managed by government. Previous research suggests that public housing has a positive impact on personal finances and education outcomes, but less is known about if/how it impacts health and healthcare use. Objectives and ApproachUsing linked administrative health and social data, we tested for changes in healthcare use among a cohort who moved into public housing in 2012 and 2013 in Manitoba, Canada, and compared utilization to a matched general population cohort who did not move into public housing. Generalized linear models with generalized estimating equations tested for differences in numbers of healthcare contacts in the years before and after the move-in date, adjusted for economic, residential mobility, and health characteristics. The data were modeled using a Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), or a binomial (odds ratio, OR) distribution. ResultsThere were 2619 residents in the public housing cohort; 99.7% were matched to the general population. The cohort by time interaction was statistically significant for inpatient days (p Conclusion/ImplicationsPublic housing residents were more likely to use healthcare services than the matched population, but changes in use were similar in the two cohorts. There is little evidence that public housing impacts healthcare use, but it serves an important function of meeting basic needs for a vulnerable population group.

Download Full-text

A population-based cohort study on the association of dietary patterns with sleep duration: A Joint modeling by mental health status

10.21203/rs.3.rs-37401/v1 ◽

2020 ◽

Author(s):

Somaye Hosseini ◽

Reyhaneh Rikhtehgaran Rikhtehgaran ◽

Noushin Mohammadifard ◽

Hamidreza Roohafza ◽

Masoumeh Sadeghi ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Health Status ◽

Sleep Duration ◽

Dietary Patterns ◽

Negative Binomial ◽

Joint Modeling ◽

Population Based ◽

Mental Health Status ◽

Western Diet

Abstract Background: We investigated the association of dietary patterns and sleep duration by controlling mental health status (MHS) using a joint modeling approach.Methods and materials: The population based cohort study was conducted within the framework of the Isfahan Cohort Study (ICS), including 1383 participants, aged ≥ 35 years were followed from 2007 to 2013. A validated food frequency questionnaire was applied to obtain dietary patterns. Anthropometric measurements, blood pressure, fasting serum lipids and blood sugars were evaluated in both phases of the study. A random effect joint negative binomial and ordinal model were used to estimate diets effect on sleep duration and MHS.Results: Three dietary patterns were identified: Healthy, Iranian and Western dietary patterns. After adjustment for potential confounders, the higher scores of Western diet were associated with sleep hours (OR=1.08 and 95% CI: 1.02‒1.12), the higher scores of the Western diet during the 5 year follow-up was associated with greater sleep duration. Sleep duration and MHS were adversely associated (-0.097 and 95% CI: -0.09‒-0.05)Conclusion: Joint modeling by MHS, sleep duration was positively affected only by western diet. Iranian and healthy diet weren’t associated by sleep hours.

Download Full-text

Whole-body MRI in neurofibromatosis: incidental findings and prevalence of scoliosis

Skeletal Radiology ◽

10.1007/s00256-011-1333-x ◽

2011 ◽

Vol 41 (8) ◽

pp. 917-923 ◽

Cited By ~ 15

Author(s):

Jacob L. Jaremko ◽

Peter J. MacMahon ◽

Martin Torriani ◽

Vanessa L. Merker ◽

Victor F. Mautner ◽

...

Keyword(s):

Incidental Findings ◽

Whole Body ◽

Whole Body Mri

Download Full-text

Can We Diagnose a Patient’s Caries Activity Based on Lesion Activity Assessment? Findings from a Cohort Study

Caries Research ◽

10.1159/000509871 ◽

2020 ◽

Vol 54 (3) ◽

pp. 218-225

Author(s):

Marisa Maltz ◽

Felipe Lappann Leal ◽

Mario Bernardes Wagner ◽

Julio Eduardo do Amaral Zenkner ◽

Carolina Doege Brusius ◽

...

Keyword(s):

Cohort Study ◽

Negative Binomial ◽

Predictor Variable ◽

Negative Binomial Regression ◽

Population Based ◽

Time Interval ◽

Active Lesion ◽

Caries Activity ◽

Activity Assessment ◽

Caries Progression

This cohort study evaluated the fate of sound surfaces and inactive non-cavitated (INC) and active non-cavitated (ANC) caries lesions in a population-based sample of South Brazilian adolescents, in answer to the question: “Is lesion activity assessment a reliable criterion to diagnose a patient’s caries activity?” A total of 801 schoolchildren were examined at baseline (aged 12 years) and after a mean time interval of 2.5 years. Data collection included a questionnaire and clinical examination. Patients were classified as caries-free (patients without any lesion), caries-inactive (patients with only inactive lesions), and caries-active (patients with at least one active lesion). The primary outcome was caries progression (presence of cavity, underlying dentin shadow, filling, or extraction at the follow-up exam). Negative binomial regression models were used to estimate the risk for caries progression. The main predictor variable was status of the surface at baseline: sound, INC, or ANC. Progression rates of 1.0, 9.0, and 12.6% were found for sound surfaces, INC, and ANC, respectively. INC (incidence risk ratio [IRR] 5.37, 95% CI 4.22–6.83) and ANC (IRR 4.96, 95% CI 3.43–7.17) had greater risk for caries progression than sound surfaces. Similar risks for progression were found for ANC and INC (IRR 0.92, 95% CI 0.64–1.32). Progression rates were 0.6, 1.1, and 2.2% for caries-free, caries-inactive, and caries-active individuals, respectively (p < 0.05). The risk for caries progression of sound surfaces was higher among caries-active adolescents (caries-free: IRR 2.78, 95% CI 1.63–4.72; caries-inactive: IRR 2.19, 95% CI 1.65–2.90). Caries-inactive patients behaved similarly to caries-free individuals (IRR 1.27, 95% CI 0.73–2.20). This study demonstrated the possibility of defining a patient’s caries activity profile based on lesion features.

Download Full-text