CT Scan to Screen for Occult Cancer in Unprovoked Venous Thromboembolism (VTE)


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CHUN WAI Wong1,Kelly Lim1,Rachel Garnett1,Harris Khan1,Faisal Solkar1,Shahab Abbas1
1ROYAL STOKE UNIVERSITY HOSPITAL

Abstract

Background

The NICE guideline suggests CT abdomen/pelvis screening for patients with first unprovoked VTE aged 40 years and above without any signs or symptoms of cancer. A recent review of the benefits of such screening has been inconclusive. We aimed to investigate the numbers of cancer identified via CT scan in unprovoked VTE and their outcomes.

Method

We conducted a retrospective study at a teaching hospital. Patients who had VTE (PE or DVT) between 1stJan and 31st July 2018 were identified. Electronic patient records were reviewed to retain patients with unprovoked VTE who had screening CT scan performed. Follow up were done until 15th April 2019.

Results

Our study included 251 unprovoked VTE patients with a median age of 69.5 years. Cancers were identified in 7/25 (2.8%) patients without any signs or symptoms of cancer. The types of cancers diagnosed include pancreatic, gallbladder, colorectal, bladder, and follicular lymphomas. Two patients passed away while five patients are still under follow up with a median survival of 12 months. Apart from one patient with benign lymphoma, the remaining four patients received active treatments with three demonstrating good response. For subgroup analysis, 122/251 patients had PE and 136/251 patients had DVT (7 patients had both PE and DVT). Cancers were diagnosed in 0(0%) and 7(5.1%) patients in the PE and DVT group respectively.

Conclusion

The proportion of patients with unprovoked VTE found to have cancer was 2.8% with all of the patients identified from the DVT group. The risk of radiation exposure and benefit of early cancer detection was not satisfied in the PE group. However, the cancer detection rate in the DVT group was high (5.1%) with most of the patients who received active intervention showing good response. Further effort is required to investigate if CT scan screening limited for unprovoked DVT would be more cost-effective.