Helfer Hélène, Skaff Yara, Happe Florent, Djennaoui Sadji, Chidiac Jean, Poénou Géraldine, Righini Marc, Mahé Isabelle
Service de Médecine Interne, Hôpital Louis Mourier, Assistance Publique des Hôpitaux de Paris (AP-HP), 92700 Colombes, France.
Université Paris Cité, 75006 Paris, France.
Cancers (Basel). 2023 Jun 2;15(11):3031. doi: 10.3390/cancers15113031.
Venous thromboembolic disease (VTE) is a common complication in cancer patients. The currently recommended VTE diagnostic approach involves a step-by-step algorithm, which is based on the assessment of clinical probability, D-dimer measurement, and/or diagnostic imaging. While this diagnostic strategy is well validated and efficient in the noncancer population, its use in cancer patients is less satisfactory. Cancer patients often present nonspecific VTE symptoms resulting in less discriminatory power of the proposed clinical prediction rules. Furthermore, D-dimer levels are often increased because of a hypercoagulable state associated with the tumor process. Consequently, the vast majority of patients require imaging tests. In order to improve VTE exclusion in cancer patients, several approaches have been developed. The first approach consists of ordering imaging tests to all patients, despite overexposing a population known to have mostly multiple comorbidities to radiations and contrast products. The second approach consists of new diagnostic algorithms based on clinical probability assessment with different D-dimer thresholds, e.g., the YEARS algorithm, which shows promise in improving the diagnosis of PE in cancer patients. The third approach uses an adjusted D-dimer threshold, to age, pretest probability, clinical criteria, or other criteria. These different diagnostic strategies have not been compared head-to-head. In conclusion, despite having several proposed diagnostic approaches to diagnose VTE in cancer patients, we still lack a dedicated diagnostic algorithm specific for this population.
静脉血栓栓塞性疾病（VTE）是癌症患者常见的并发症。目前推荐的VTE诊断方法涉及一种逐步算法，该算法基于临床概率评估、D-二聚体检测和/或诊断性影像学检查。虽然这种诊断策略在非癌症人群中得到了充分验证且有效，但其在癌症患者中的应用效果不太理想。癌症患者常出现非特异性VTE症状，导致所提出的临床预测规则的鉴别能力降低。此外，由于与肿瘤过程相关的高凝状态，D-二聚体水平通常会升高。因此，绝大多数患者需要进行影像学检查。为了提高癌症患者VTE的排除率，已开发出几种方法。第一种方法是对所有患者进行影像学检查，尽管这会使已知大多患有多种合并症的人群过度暴露于辐射和造影剂中。第二种方法是基于临床概率评估和不同D-二聚体阈值的新诊断算法，例如YEARS算法，该算法在改善癌症患者PE的诊断方面显示出前景。第三种方法是根据年龄、检测前概率、临床标准或其他标准调整D-二聚体阈值。这些不同的诊断策略尚未进行直接比较。总之，尽管有几种针对癌症患者诊断VTE的建议诊断方法，但我们仍然缺乏专门针对该人群的诊断算法。
