来自全科医疗的有非特异性癌症症状的患者：症状与影像学的回顾性研究
Patients from general practice with non-specific cancer symptoms: a retrospective study of symptoms and imaging.
作者信息
de Chiffre Jonas Michele Dorph, Ormstrup Tina Elisabeth, Kusk Martin Weber, Hess Søren
机构信息
Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark.
出版信息
BJGP Open. 2024 Apr 25;8(1). doi: 10.3399/BJGPO.2023.0058. Print 2024 Apr.
BACKGROUND
Patients with non-specific symptoms or signs of cancer (NSSC) present a challenge as they are a heterogeneous population who are not candidates for fast-track work-up in an organ-specific cancer pre-planned pathway (CPP). Denmark has a cancer pre-planned pathway for this population (NSSC-CPP), but several issues remain unclarified, for example, distribution and significance of symptoms and findings, and choice of imaging.
AIM
To investigate symptoms, cancer diagnoses, and diagnostic yield of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) in patients on NSSC-CPP to improve the overall diagnostic process.
DESIGN & SETTING: A retrospective medical chart review in a 1-year consecutive cohort (2020).
METHOD
A total of 802 referrals were reviewed for diagnostic imaging in patients with NSSP from general practices, specialist practices, or the local hospital diagnostic centre responsible for NSSC-CPP.
RESULTS
The study included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity of 85%, specificity of 87%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 96%. For F-FDG-PET/CT, the numbers were sensitivity 82%, specificity 62%, PPV 33%, and NPV 94%. Patients frequently underwent subsequent examinations following initial imaging.
CONCLUSION
The findings were in accordance with the literature. Patients with NSSC had a cancer prevalence of 21%, most frequently gastrointestinal. The most frequent symptom was weight loss and, even as the only symptom, it is a potential marker for cancer. CT and F-FDG-PET/CT were sensitive with high NPV, whereas PPV was superior in CT. Better stratification by symptoms or findings is an obvious focus point for future studies to further optimise the NSSC-CPP work-up strategy.
背景
患有非特异性癌症症状或体征（NSSC）的患者是一个异质性群体，不适合在器官特异性癌症预规划路径（CPP）中进行快速检查，这给临床带来了挑战。丹麦针对这一群体制定了癌症预规划路径（NSSC-CPP），但仍有几个问题尚未明确，例如症状和检查结果的分布及意义，以及成像检查的选择。
目的
调查NSSC-CPP患者的症状、癌症诊断以及计算机断层扫描（CT）和氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG-PET/CT）的诊断率，以改善整体诊断流程。
设计与设置
对一个连续1年的队列（2020年）进行回顾性病历审查。
方法
共审查了802例来自全科诊所、专科诊所或负责NSSC-CPP的当地医院诊断中心的NSSP患者的诊断性影像学检查转诊病例。
结果
该研究纳入了248例患者；21%患有癌症，最常见的是胃肠道癌症（27%）。最常见的症状是体重减轻（56%）。CT的敏感性为85%，特异性为87%，阳性预测值（PPV）为65%，阴性预测值（NPV）为96%。对于F-FDG-PET/CT，相应数字分别为敏感性82%，特异性62%，PPV 33%，NPV 94%。患者在初次成像后经常接受后续检查。
结论
研究结果与文献一致。NSSC患者的癌症患病率为21%，最常见的是胃肠道癌症。最常见的症状是体重减轻，即使作为唯一症状，也是癌症的潜在标志物。CT和F-FDG-PET/CT具有较高的敏感性和NPV，而CT的PPV更高。通过症状或检查结果进行更好的分层是未来研究进一步优化NSSC-CPP检查策略的一个明显重点。
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