Stratifying Risk in Incidentally Detected Splenomegaly: Quantitative Thresholds for Hematologic and Hepatic Surveillance

Highlights

• Spleen volume ≥500 mL or length ≥140 mm serves as a critical threshold, where the 5-year absolute risk of hematologic cancer reaches up to 46% in elderly populations.
• Incidentally detected splenomegaly is a potent predictor not only of hematologic malignancies but also of cirrhosis and primary liver cancer.
• Specific quantitative cutoffs (length 130-139 mm; volume 400-499 mL) define a ‘moderate risk’ zone requiring clinical vigilance.
• The integration of age, sex, and splenic metrics is essential for personalized risk assessment and determining the necessity of invasive workups like bone marrow biopsy.

Background