How are incidentally detected splenic lesions generally managed?
In patients without a history of cancer, indeterminate splenic lesions are followed over time with imaging if no suspicious features are present, whereas lesions with suspicious features are further evaluated with MRI, 18 F-fluorodeoxyglucose positron emission tomography (FDG PET), or tissue sampling. Suspicious imaging features include heterogeneous attenuation or signal intensity, solid areas of enhancement, irregular margins, presence of necrotic areas, splenic parenchymal or vascular invasion, large size, and growth over time. In patients with a history of cancer, subcentimeter splenic lesions are followed over time with imaging, whereas lesions ≥1 cm are further evaluated with MRI, FDG PET, or tissue sampling given the greater likelihood of metastatic disease.
