Systematic screening for occult cancer in elderly patients with venous thromboembolism: a prospective study

Rieu, V.; Chanier, S.; Philippe, Pierre; Ruivard, M.

doi:10.1111/j.1445-5994.2011.02448.x

Cited by 19 publications

(15 citation statements)

References 37 publications

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“…The incidence of malignancy in our study (2.5%, 95% CI: 0.6%-12.9%) was slightly lower than reported in other studies utilizing various types of comprehensive cancer screening in patients with idiopathic VTE [5,7,9,10]. This may be due, in part, to the younger cohort of patients in our study and the higher incidence of malignancy in older subjects [10].…”

Section: Discussioncontrasting

confidence: 80%

“…In selected patients, a comprehensive cancer screening strategy may be considered. Prior clinical investigations have studied the utility and cost of various screening strategies, including the incorporation of cancer biomarkers, ultrasound, and CT imaging [5-10]. Nevertheless, controversy exists with regard to how extensive the assessment should be and whether it is cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of screening strategies have been studied, including the use of extensive laboratory testing and more extensive diagnostic imaging with ultrasound and computed tomography (CT) [5-10]. Unfortunately, universal agreement with regards to the optimal screening approach is lacking.…”

Section: Introductionmentioning

confidence: 99%

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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

Rondina¹,

Wanner²,

Pendleton³

et al. 2012

Thrombosis Research

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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.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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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

Rondina¹,

Wanner²,

Pendleton³

et al. 2012

Thrombosis Research

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“…Patients with idiopathic VTE have a high risk of being diagnosed with cancer [13,17,20,21,22,23,24,25,26,27,28,29]. This also applies to superficial thrombophlebitis [24,30].…”

Section: Occult Malignancy and Idiopathic Vtementioning

confidence: 99%

“…The cancer risk is higher in young patients with VTE (e.g. < 60 years) than in the elderly [21,26,27,29] because the latter have more competing risk factors. It is also higher with bilateral or recurrent VTE [39,40,41].…”

Section: Occult Malignancy and Idiopathic Vtementioning

confidence: 99%

Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis

Matzdorff

Riess

Bergmann³

et al. 2015

Oncol Res Treat

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Cancer can trigger thromboembolism. There is a 4-10% chance of finding an asymptomatic occult cancer in patients with idiopathic venous thromboembolism (VTE). Current guidelines recommend limited cancer screening with history, physical examination, and screening examinations according to age after idiopathic VTE. Recent studies found that a more extensive screening program, including endoscopy and computed tomography, may increase the cancer detection rate. The Hemostasis Working Group of the German Society of Hematology and Oncology recommends a more extensive screening program after idiopathic VTE.

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

Alfonso

Redondo

Rubio³

et al. 2013

Intl Journal of Cancer

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Extensive screening strategies to detect occult cancer in patients with unprovoked venous thromboembolism (VTE) are complex and no benefit in terms of survival has been reported. FDG-PET/CT (2-[F-18] fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography), a noninvasive technique for the diagnosis and staging of malignancies, could be useful in this setting. Consecutive patients 50 years with a first unprovoked VTE episode were prospectively included. Screening with FDG-PET/CT was performed 3-4 weeks after the index event. If positive, appropriate diagnostic work-up was programmed. Clinical follow-up continued for 2 years. Blood samples were collected to assess coagulation biomarkers. FDG-PET/CT was negative in 68/99 patients (68.7%), while suspicious FDG uptake was detected in 31/99 patients (31.3%). Additional diagnostic work-up confirmed a malignancy in 7/31 patients (22.6%), with six of them at early stage. During follow-up, two patients with negative FDG-PET/CT were diagnosed with cancer. Sensitivity (S), positive (PPV) and negative predictive values (NPV) of FDG-PET/CT as single tool for the detection of occult malignancy were 77.8% (95% CI: 0.51-1), 22.6% (95% CI: 0.08-0.37) and 97.1% (95% CI: 0.93-1), respectively. Median tissue factor (TF) activity in patients with occult cancer was 5.38 pM vs. 2.40 pM in those without cancer (p 5 0.03). Limitation of FDG-PET/CT screening to patients with TF activity > 2.8 pM would improve the PPV to 37.5% and reduce the costs of a single cancer diagnosis from 20,711e to 11,670e. FDG-PET/CT is feasible for the screening of occult cancer in patients with unprovoked VTE, showing high S and NPV. The addition of TF activity determination may be useful for patient selection.Cancer patients have an increased risk of venous thromboembolism (VTE), either deep vein thrombosis (DVT) or pulmonary embolism (PE), through different mechanisms, including tumor-and treatment-induced hypercoagulability, endothelial damage (chemotherapy toxicity and use of venous catheters) or venous stasis due to bed rest or surgical immobilization.

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Systematic screening for occult cancer in elderly patients with venous thromboembolism: a prospective study

Cited by 19 publications

References 37 publications

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

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

Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis

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

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