Diseases Detected Incidentally During Physical Examinations: Clinical Significance and Awareness

Abstract

 Background: In medical checkups, imaging tests and blood data sometimes reveal diseases that are not the original purpose of the examination. This report describes diseases incidentally discovered from medical checkup data at our medical checkup facility.

 Subjects: I. 2,426 patients who underwent pulmonary helical CT at our facility during a 6-month period. II. 13,550 patients who visited our facility during one year.

 Subjects and Methods: I. For patients with coronary artery calcification on CT, a thorough examination was recommended. Coronary risk factors and the presence of significant stenosis were examined. II. Hypophosphatasemia (HPP) is an inborn error of metabolism caused by genetic mutation, and a low serum ALP level is one of the diagnostic criteria. Patients with low serum ALP levels (33 U/L or less in men and 29 U/L or less in women) were recommended a thorough examination to verify the prevalence of HPP.

 Results: I. We validated 2,426 patients who underwent CT and found coronary artery calcification in 296 (12%). Compared to the negative subjects, those who were positive for calcification had a significantly higher prevalence of coronary risk factors except eGFR. Of the 296 patients with calcification, we were able to confirm medical consultation and test results in 80 patients; 16 of the 80 patients underwent PCI (percutaneous coronary angioplasty) and had a significantly higher prevalence of diabetes mellitus. II. Out of 13,055 patients (8,607 males and 4,943 females), 79 patients were found to have low ALP and were advised to visit the Outpatient Genetics. 12 patients visited the Outpatient Genetics and 10 patients (5 males and 5 females) were found to have positive gene tests.

 Discussion: Although these diseases found in medical checkups are unrelated to the original purpose of medical checkups, they are thought to lead to the prevention of serious complications and the diagnosis of undiagnosed diseases. Because health checkups handle a large amount of data, it is necessary to give consideration to undetected diseases. On the other hand, there are issues to be addressed in the prognostic tracking of health checkup results and the difficulty of raising awareness of diseases.