Highlights
- •Venous thromboembolism can occur as the first manifestation of an occult malignancy.
- •Concern for the use of FDG PET/CT for screening is the risk for unnecessary additional tests.
- •No difference of additional procedures following each screening strategy was observed.
- •Higher number of invasive tests in the FDG PET/CT arm.
Abstract
18F-Fluorodesoxyglucose Positron-Emission-Tomography combined with Computed-Tomography
(FDG PET/CT) might be an attractive tool for cancer screening in patients with venous
thromboembolism (VTE), allowing non-invasive whole-body imaging. One of the frequent
criticisms to the use of FDG PET/CT for screening is the potential for false positive
results leading to unnecessary/invasive investigations.
Our aim was to compare the frequency and invasiveness of additional testing following
extensive and limited screening strategies for occult malignancy in patients with
unprovoked VTE.
We analysed patients included in the MVTEP study, a randomized trial that compared
a screening strategy based on FDG-PET/CT with a limited screening strategy for occult
malignancy diagnosis in patients with unprovoked VTE. All additional diagnostic procedures
following screening were recorded and classified as invasive or non-invasive.
A total of 394 patients were analysed. Additional diagnostic procedures realized in
patients of each group consisted of 59 tests in patients of the FDG PET/CT group versus
53 tests among the patients from the limited screening group (p = 0.65). Overall, 45 (22.8%) patients in the FDG PET/CT group underwent additional diagnostic
tests, versus 32 (16.2%) in the limited screening group (absolute risk difference + 6.6%, 95% CI −1.3 to +14.4%, p = 0.13). Sixteen (8.1%) patients in the FDG PET/CT group underwent invasive procedures,
versus 6 (3%) in the limited screening group (absolute risk difference + 5.1%, 95% CI +0.5 to +10.0%, p = 0.03).
We found no statistical difference in the number of additional procedures following
each screening strategy. However, a higher number of invasive tests were performed
in the FDG PET/CT group.
Abbreviations:
FDG PET/CT (18F-Fluorodesoxyglucose Positron-Emission-Tomography combined with Computed-Tomography), MRI (magnetic resonance imaging), US (ultrasonography), VTE (venous thromboembolism)Keywords
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Article info
Publication history
Published online: April 25, 2017
Accepted:
April 22,
2017
Received in revised form:
April 7,
2017
Received:
February 2,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
