Purpose: Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician's discretion. Being a sensitive non-invasive whole-body imaging modality 18 F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18 F-FDG-PET/CT in SSD using long-term follow-up as reference. Methods: We retrospectively studied results obtained in all SSD patients referred for 18 F-FDG-PET/CT at a single institution in 2010-2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from six months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsyconfirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis. Results: Ninety-three patients, aged 67 years (range 25-89) were included and followed for up to 7.3 years (median 6). Of these, 21 (22.6% [95% CI: 15.3-32.1]) turned out to have cancer. With 18 F-FDG-PET/CT, the sensitivity was 81.0% (95% CI: 60.0-92.3), specificity 76.4% (95% CI: 65.4-84.7), positive predictive value 50% (95% CI: 34.1-65.9), and negative predictive value 93.2% (95% CI: 83.8-97.3). Five patients with negative scans were subsequently diagnosed with cancer. Conclusion: Cancer prevalence is substantial among patients with SSD. 18 F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18 F-FDG-PET/CT in SSD.

BackgroundPolymyalgia Rheumatica (PMR) is a common inflammatory autoimmune rheumatic disease, with the highest incidence rates seen in Scandinavia.One of the challenges in the diagnosis of PMR is the lack of diagnostic tests specific for the disease. The diagnosis may require exclusion of other conditions that can present with polymyalgia symptoms and may lead to hospitalization. Only limited data on hospitalization rates among patients with PMR exists (1).Ultrasound (US) may be useful in differentiating PMR from non-inflammatory conditions and can also be used for the diagnosis of concomitant Giant Cell Arteritis (GCA)GCA Fast Track Clinics (FT) using US as the main diagnostic tool have shown both improvement in patient outcomes and decrease in the cost of care(2)ObjectivesTo investigate the admission rates of patients diagnosed with PMR and the impact of the FT on these rates.MethodsA FT clinic for patients suspected to have PMR was established at rheumatological outpatient clinic of South-West Jutland Hospital (serving 250.000inhabitants) in January 2018. Collaboration with the Emergency Medical department was established and patients with PMR symptoms referred to the hospital were examined at FT within 0-1 days, thereby avoiding hospitalization. Similarly, patients referred with PMR symptoms to the outpatient clinic by a GP, were examined at FT within 1-2 days. At FT a thorough history and clinical examination were performed including musculoskeletal and vascular US. Retrospectively data from patients diagnosed with PMR from 2013-2018 was analyzed.ResultsIn a 6 years’ period, 336 patients were diagnosed with PMR. 54 patients were diagnosed during hospitalization. Hospitalized patients were older (mean values ± standart deviaton-sd) 73,61±8,96 vs 70,94±7,97 years, p=0,024, with significantly higher initial C-reactive protein(CRP, mg/l) levels 99±58,8 vs 43,9±37,p<0,0001 and a shorter duration of symptoms(6,92±5,5 vs 13,6±13,7 weeks, p=0,0018). No differences were found regarding gender, PMR related symptoms, initial prednisolone dose and response to treatment. An equal annual distribution of the number of new diagnosed cases and hospitalizations rates during the first 5 years was found. After the implementation of the FT at January 2018 a significant decrease in hospitalization rates (19,4% vs 3,5% p=0,001) and inpatient days of care (4,15±3,1 vs 1±0, p<0,0001) was observed. The time from symptoms debut to diagnosis was also significantly decreased from 13, 74 to 6, 79 weeks (Table)Diagnosed at2013-2017N 268Diagnosed at2018N 56P valuesAge (years) mean ± sd71,3 ± 8,571,79 ± 6,6n.s*Gender (female)58,2%48,2%n.sDuration of symptoms (weeks) mean± sd13,74± 13,746,79 ± 4,720,001Bilateral shoulder pain95,9%98,2%n.sAbnormal CRP and/or SR at debut91,8%100%0,03CRP (mg/lt) mean± sd52,82 ± 48,3 56,5 ± 37,2n.sMorning stiffness90,3%92,7%n.sHip pain or limited range of motion71,4%61,8%n.sRF and aCCP negative95,1%100%n.sAbsence of other joint involvement72%75%n.sInitial prednisolone dose (mg) mean± sd18,44 ± 8,4119,2 ± 9,25n.sH...