Zusammenfassung
Als Nebenprodukt einer starken Zunahme von hochauflösender radiologischer (Schnitt‑)Bildgebung steigt die Prävalenz von Zufallsbefunden („incidental findings“, IF) seit Jahren an. Die Entdeckung eines Zufallsbefundes kann die frühzeitige Behandlung einer möglicherweise schwerwiegenden Erkrankung ermöglichen und den Krankheitsverlauf so entscheidend verändern. Viele Zufallsbefunde haben allerdings keine oder nur geringe gesundheitliche Auswirkungen, und dennoch führt ihre Entdeckung häufig zu einer Kaskade zusätzlicher Untersuchungen und Interventionen. Es ist unstrittig, dass Zufallsbefunde einen direkten Einfluss auf das Leben der betroffenen Personen haben können und nicht nur psychosoziale Aspekte wie bspw. Sorgen und Ängste durch falsch-positive Befunde eine Rolle spielen, sondern unter Umständen auch versicherungsrechtliche oder berufliche Probleme auftreten können. Deshalb rufen der richtige Umgang mit Zufallsbefunden und die dabei geltenden ethischen Herausforderungen regelmäßig Diskussionen hervor. Allgemeine Prinzipien, die bei der Behandlung von Zufallsbefunden zu berücksichtigen sind, umfassen einerseits die Verantwortung für das Wohlergehen des Patienten/Studienteilnehmers selbst und andererseits auch die Verantwortung für Wohlergehen der möglicherweise mitbetroffenen Gesellschaft. Um Überdiagnosen und Übertherapien zu vermeiden und einen hohen Nutzen für die Patienten zu erzielen, müssen Radiologen und Kliniker wissen, wie man mit Zufallsbefunden umgeht. In den letzten Jahren wurden von verschiedenen nationalen und internationalen Gesellschaften wichtige Leitlinien („White Papers“) zum Management von IF veröffentlicht. Es ist wichtig, dass Radiologen diese Leitlinien genau kennen und einhalten und dann auch für überweisende Ärzte zur Diskussion und Beratung zur Verfügung stehen. Bei allen Entscheidungen muss dabei immer der Patient im Mittelpunkt stehen.
Abstract
As a byproduct of the increased use of high-resolution radiological imaging, the prevalence of incidental findings (IFs) has been increasing for years. The discovery of an incidental finding can allow early treatment of a potentially health-threatening disease and thus decisively change the course of the disease. However, many incidental findings are of low risk with little or no health impact, and yet their discovery often leads to a cascade of additional investigations. It is undisputed that incidental findings can have a direct impact on the life of the person and that not only psychosocial aspects such as worries and anxiety due to false-positive findings play a role, but that insurance, legal or professional problems can also occur under certain circumstances, which is why the correct handling of incidental findings and the accompanying ethical challenges that apply to them regularly give rise to discussions. General principles to consider when managing incidental findings are responsibility for the well-being of the patient/study participant and of society. In order to avoid overdiagnosis and overtreatment and to achieve high patient benefit, radiologists and clinicians must know how to properly deal with IFs. In recent years, various national and international societies have published important guidelines (“white papers”) on how to deal with the management of IFs. It is important that radiologists are fully aware of and follow these guidelines and are also available to referring physicians for further discussions and advice. The most important fact is that the well-being of the patient must always be at the center of all decisions.
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S. Weckbach gibt eine Tätigkeit bei Bayer AG an. M.O. Wielpütz und O. von Stackelberg geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Weckbach, S., Wielpütz, M.O. & von Stackelberg, O. Patientenzentriertes, wertbasiertes Management von radiologischen Zufallsbefunden. Radiologie 63, 657–664 (2023). https://doi.org/10.1007/s00117-023-01200-0
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DOI: https://doi.org/10.1007/s00117-023-01200-0