Vaidyanathan S, Walsh J, Cliffe H, Saleem N, Weston M J, Lowe A S, Chowdhury F U
Department of Clinical Radiology, Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Department of Clinical Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK.
Clin Radiol. 2016 Jun;71(6):501-6. doi: 10.1016/j.crad.2016.02.016. Epub 2016 Mar 19.
To analyse the positive rate for cancer on additional abdominopelvic computed tomography (CT) in patients with unprovoked venous thromboembolism (VTE), evaluate the subsequent emergence of a cancer diagnosis in the clinical follow-up period, and identify any possible predictive factors of cancer in this cohort, which may allow better selection of patients for additional imaging.
Consecutive adult patients with VTE were retrospectively identified in two large teaching hospitals between January 2013 and June 2014, including a subset of those with unprovoked VTE. Relevant demographic data were extracted and analysed. All patients had a minimum of 12 months clinicoradiological follow-up.
One thousand four hundred and forty-six patients with VTE were deemed eligible, of which 699 (48%) were male; the median age (range) was 66 (16-102) years. The prevalence of pre-existing cancer in these patients was 343/1446 (24%), and 388/1446 (27%) were classified as unprovoked VTE. In 12/1446 (0.8%), cancer was diagnosed synchronously with VTE on the initial imaging investigation. Additional screening imaging was performed in 232/388 (60%) including abdominopelvic CT in 205 (53%) patients with unprovoked VTE. Only five additional cancers were identified, all of these occurring in patients with clinical symptoms suspicious for cancer. None of the additional CT examinations identified any clinically occult cancer in asymptomatic patients, and subsequent mean follow-up of 22 (SD=6) months also failed to reveal any further cancer diagnosis.
Contrary to the National Institute of Health and Care Excellence (NICE) guidance, the yield of performing additional abdominopelvic CT as a screening tool for occult cancer in asymptomatic patients with unprovoked VTE is negligible. A more selective and clinically-driven assessment of these patients is recommended.
分析不明原因静脉血栓栓塞症（VTE）患者进行额外腹盆腔计算机断层扫描（CT）的癌症阳性率，评估临床随访期间后续癌症诊断的出现情况，并确定该队列中癌症的任何可能预测因素，这可能有助于更好地选择患者进行额外的影像学检查。
回顾性纳入2013年1月至2014年6月期间在两家大型教学医院连续就诊的成年VTE患者，包括不明原因VTE患者亚组。提取并分析相关人口统计学数据。所有患者至少进行了12个月的临床和影像学随访。
1446例VTE患者符合条件，其中699例（48%）为男性；中位年龄（范围）为66（16 - 102）岁。这些患者中既往癌症的患病率为343/1446（24%），388/1446（27%）被归类为不明原因VTE。在12/1446（0.8%）的患者中，在初始影像学检查时癌症与VTE同时被诊断。232/388（60%）的患者进行了额外的筛查影像学检查，其中205例（53%）不明原因VTE患者进行了腹盆腔CT检查。仅发现另外5例癌症，所有这些均发生在有癌症可疑临床症状的患者中。额外的CT检查均未在无症状患者中发现任何临床隐匿性癌症，随后平均22（标准差 = 6）个月的随访也未发现任何进一步的癌症诊断。
与英国国家卫生与临床优化研究所（NICE）的指南相反，对于不明原因VTE的无症状患者，将额外的腹盆腔CT作为隐匿性癌症筛查工具的检出率可忽略不计。建议对这些患者进行更具选择性和临床驱动的评估。
