Screening for occult malignancy with FDG-PET/CT in patients with unprovoked venous thromboembolism
Magazine: International Journal of Cancer
Date: Apr 24, 2013Nuclear Medicine [SP] Hematología y Hemoterapia [SP]
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, a non-invasive 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%), 6 of them at early stage. During follow-up 2 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 TF activity in patients with occult cancer was 5.38 pM vs 2.40 pM in those without cancer (p=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 20,711€ to 11,670€. 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.
CITATION Int J Cancer. 2013 Apr 24. doi: 10.1002/ijc.28229
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