Impact of incidental findings in preoperative CTA imaging for autologous breast reconstruction.

Background: CT angiography (CTA) can be performed pre-operatively for perforator mapping in autologous breast reconstruction. The full impact of incidental CTA findings on breast reconstruction remains unclear.

Methods: CTAs were reviewed for all patients who underwent imaging prior to autologous breast reconstruction at Yale New Haven Hospital from 2013-2018. CTA findings and all resulting follow-up imaging, treatment, and change in management were catalogued. Our findings were compared to other published reports in the literature to better categorize the impact of CTA findings on patient care.

Results: Records from 341 patients were reviewed. One hundred fifty-four patients (45.2%) had incidental findings with 15.6% requiring further imaging or biopsy. Three patients (0.9%) underwent a change in management. One patient was diagnosed with metastatic disease prior to mastectomy. Another two patients required gynecologic procedures as a result of the CTA findings. Data was pooled with three other series in the literature for aggregate analysis of 959 operative planning CTAs. In total, incidental findings were present in 53.7% of patients. In the meta-analysis, 10.4% of patients required additional imaging or biopsy and 1.4% of screening CTAs impacted medical management.

Conclusion: Pre-operative autologous breast reconstruction planning reveals incidental findings in approximately half of all imaging studies. In an analysis of nearly 1000 CTAs, patient care was impacted in 1.4% of cases. If imaging is obtained for planning purposes, the reconstructive microsurgeon should carefully review the full imaging report given its potential impact on patient care.