A pilot study utilizing whole body 18 F-FDG-PET/CT as a comprehensive screening strategy for occult malignancy in patients with unprovoked venous thromboembolism

Abstract

Background Approximately 7-10% of patients with unprovoked VTE will be diagnosed with cancer within 12 months. Although cancer screening has been proposed in these patients, the optimal strategy remains unclear. In a pilot study, we prospectively investigated the use of FDG-PET/CT to screen for occult malignancy in 40 patients with unprovoked VTE. Materials/Methods Patients were initially screened for occult malignancy with a focused history, physical, and laboratory evaluation. Patients underwent whole body FDG-PET/CT and were followed for up to two years for a new diagnosis of cancer. The total costs of using FDG-PET/CT as a comprehensive screening strategy were determined using 2010 Medicare reimbursement rates. Results Completion of FDG-PET/CT imaging was feasible and identified abnormal findings requiring additional evaluations in 62.5% of patients. Occult malignancy was evident in only one patient (cancer incidence 2.5%) and FDG-PET/CT imaging excluded malignancy in the remainder of patients. No patients with a negative FDG-PET/CT were diagnosed with malignancy during an average (±SD) follow-up of 449 (±311) days. The use of FDG-PET/CT to screen for occult malignancy added $59,151 in total costs ($1,479 per patient). The majority of these costs were due to the cost of the FDG-PET/CT ($1,162 per patient or 78.5% of total per-patient costs). Conclusions FDG-PET/CT may have utility for excluding occult malignancy in patients with unprovoked VTE. The costs of this comprehensive screening strategy were comparable to other screening approaches. Larger studies are needed to further evaluate the utility and cost-effectiveness of FDG-PET/CT as a cancer screening strategy in patients with unprovoked VTE.

Screening for occult malignancy with FDG‐PET/CT in patients with unprovoked venous thromboembolism

“…Herein, we report a S and Sp of FDG‐PET/CT for the detection of occult malignancy in selected patients with unprovoked VTE of 77.8 and 73.3%, respectively, with a PPV and NPV of 22.6 and 97.1%. This NPV is similar to that obtained in a recent pilot study, initiated after the beginning of our study, including only 40 patients without age limitations, in which just a single case of cancer (2.5%) was detected …”

“…Its application for the detection of occult cancer in patients with VTE could simplify the search. In a recent pilot study in a small and heterogeneous population, the use of FDG‐PET/CT as solitary screening tool for occult malignancy proved feasible with acceptable S …”

“…15 Its application for the detection of occult cancer in patients with VTE could simplify the search. In a recent pilot study in a small and heterogeneous population, the use of FDG-PET/CT as solitary screening tool for occult malignancy proved feasible with acceptable S. 16 In addition, some coagulation biomarkers such as D-dimer (DD), factor VIII (FVIII), endogenous thrombin generation potential (ETP), prothrombin fragment 112 (F112) or tissue factor (TF) have proved useful for the stratification of the risk of VTE in cancer patients. [17][18][19][20] Whether any of these tests could be useful to identify VTE patients with higher risk of occult malignancy remains unanswered.…”

Cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography in tumours other than lung cancer: A systematic review

“…Thirty-three articles were selected and retrieved in fulltext version (Figure 1). One study was found screening the references [6] and 18 articles were subsequently excluded [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Finally, 16 studies were included [6,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] .…”

“…Cost study Rondina et al [24] 2012 United States Occult (various) Cost study Table 2 Characteristics of excluded studies Annunziata S et al . Cost-effectiveness of PET in oncology patient.…”