Overdiagnosis Associated with Incidental Findings Across Medical Specialities: A Scoping Review

Abstract

Background: Overdiagnosis occurs when conditions are detected that would not have caused symptoms or death during a patient’s lifetime. A major contributor to this is the identification of incidental findings, or incidentalomas, increasingly detected with widespread use of advanced imaging. Objective: To update a 2017 scoping review on overdiagnosis by focusing specifically on incidental findings and describing how the scope, characteristics, and frequency of publications have changed over the past eight years. Methods: PubMed was searched in July 2025 using an adapted version of the 2017 search strategy combined with additional incidentaloma-related terms. Studies were eligible if they addressed overdiagnosis with a dominant focus on incidental findings. Data were extracted on anatomical site, medical specialty, article type, diagnostic test, setting, and mode of detection. Results: Of 110 records screened, 46 studies met inclusion criteria. The most common incidentalomas involved the thyroid (n = 19) and lungs (n = 8). Oncology was the most frequent specialty (55%), followed by endocrinology (13%) and pulmonology (9%). Most studies were non-methodological, descriptive, or clinical. Imaging was the predominant diagnostic test (72%), with hospital-based care the most frequently reported setting (22%). Incidentalomas were most often detected during diagnostic testing for unrelated conditions (38%). Conclusions: This review suggests a possible shift towards greater attention to overdiagnosis related to incidental findings, most often thyroid and lung incidentalomas in oncology. While many are benign or low-risk, their detection often leads to unnecessary investigations, patient anxiety, and resource use. Future research should prioritize risk-stratified management, selective reporting, and integrated follow-up systems to ensure that detection translates into patient benefit rather than harm.