Investigating the prevalence of occult malignancy in patients with unprovoked DVT


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Aleem O'Balogun, Andrea Diallo-Geny, Mohammed Azib Zahid, Muhammad Anwar

Abstract

Background

Amongst the patient population diagnosed with an unprovoked DVT, 5-10% are subsequently found to have cancer. In view of poor prognosis in these patients, suggested by research, timely diagnosis is needed. Current NICE guidance suggests an initial review of medical history, blood tests and physical examination, and to avoid further radiological investigation without relevant signs or symptoms. This saves time, money and reduces patient exposure to radiation and also anxiety associated with investigations and procedures.

Method

218 patients from 1st September 2018 – 31st August 2019 had a positive diagnosis of DVT. These patients were reviewed retrospectively and placed into groups; provoked (117) and unprovoked (89) DVT based on clinical information and their past medical history. They were further divided to reveal those patients who underwent extensive screening for malignancy (75). Electronic patient records were reviewed to confirm if malignancy was diagnosed.

Results

In this study 85 patients had a confirmed diagnosis of unprovoked DVT (49 males and 36 females) with a median age of 65.5 (range 32-93). 88% (45 males and 30 females) went on to have extensive cancer screening, with a median age of 64 (range 34-93). Screening included CT CAP +/- biopsy to investigate malignancy. In these patients, an occult malignancy prevalence of 8% was calculated. This included 4 males and 2 females, with a median age of 75.5 (range 42-82). Diagnosed cancers comprised pancreatic, liver, lymphoma, lung, and pheochromocytoma.

Conclusion

This study demonstrates an 8% prevalence of occult malignancy in patients presenting with unprovoked DVT. As it is prior to recent changes in NICE guidance, there was no existing robust screening criteria. Our study highlights the need for a dedicated ‘unprovoked DVT/PE’ pathway to screen and select high-risk patients that will need further investigations for timely diagnosis of cancer, without exposing low-risk patients to risk and preserving resources. 

Impact statement

This study will help to inform future decisions regarding pathways needed for patients presenting with an unprovoked DVT, and how imaging will aid timely diagnosis.