Background NICE guidelines advocate further investigations for cancer with an abdomino-pelvic CT scan (CT A/P) in all patients aged over 40 years with a first unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who do not have signs or symptoms of cancer based on initial investigation.1 Recent prospective study showed no difference between ‘limited’ screening and CT A/P in diagnosing occult cancer.2 We aimed to establish whether the number of new malignancies detected justified the risk of radiation exposure from performing a CT A/P in patient with unprovoked PE.
Methods We performed a retrospective analysis of all CT Pulmonary Angiograms (CTPA) performed during a one year period (2014–2015) in a district general hospital. Records of those patients with confirmed pulmonary embolism on CTPA (n = 254) were examined to ascertain whether performing CT A/P increased the detection rate of occult malignancy.
Results 124 (49%) out of a total 254 patients had an acute unprovoked PE. Of these, 6 patients were under the age of 40 years. Out of the remaining 118 patients, 80 (68%) patients underwent CT A/P. Unexpected malignancy was found in 3 (4%) of these 80 patients. No evidence of malignancy has been found in those patients that did not undergo CT A/P (n = 38) so far based on the follow up clinical encounters – both as an in-patient and outpatient.
Conclusion Our data support the finding that the routine use of CT A/P in patients with unprovoked PE doesn’t detect significant number of occult malignancies.
Singh B, et al. National institute for health and care excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Nov 2012.
Carrier M, et al. Screening for occult cancer in unprovoked venous thromboembolism. NEJM 2015;373:8.