Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months

Abstract

ObjectivesTo describe the diagnostic properties of thoracoabdominal contrast-enhanced CT (ceCT), when general practitioners (GPs) managed referral to ceCT through the non-specific symptoms or signs of cancer-cancer patient pathway (NSSC-CPP).DesignRetrospective cohort study including patients from a part of Denmark.SettingDepartment of Internal Medicine at a university hospital.ParticipantsIn total, 529 patients underwent ceCT.Primary and secondary outcomesOur primary objective was to estimate the negative and positive likelihood ratios for being diagnosed with cancer within 1 year after ceCT. Our secondary outcomes were prevalence and final diagnoses of malignancy (including temporal trends since implementation of NSSC-CPP in 2012), the prevalence of revision of CT scans and referral patterns based on ceCT results.ResultsIn total, 529 subjects underwent ceCT and malignancy was identified in 104 (19.7%) patients; 101 (97.1%) during initial workup and 3 patients during the subsequent 12 months follow-up.Eleven patients had a false-negative ceCT, and revision classified the ceCT as ‘probable/possible malignancy’ in eight (73%) patients. The negative predictive value was 98% and positive predictive value 63%. Negative and positive likelihood ratios for malignancy was 0.1 and 7.9, respectively.ConclusionOur study shows that ceCT as part of GP-coordinated workup has a low negative likelihood ratio for identifying malignancy; this is important since identifying patients for further workup is vital.

The pathway and characteristics of patients with non-specific symptoms of cancer: A systematic review

“…Analysis of the methodological quality of the included articles was assessed using the NOS methods which categorises studies scoring as low quality (0-5 stars), medium quality, (6-7 stars) and high quality (8-9 stars). All ten studies were considered to be of high quality [10,12,16,17,21,[24][25][26][27][28][29].…”

“…Eight included studies provided information about social and mental characteristics of participants [10,12,16,17,21,[23][24][25][26][27]. One study only included physical characteristics and another included physical characteristics and information about patient pathway [28,29]. Nine publications held information about physical characteristics [10,12,16,17,21,[24][25][26][27][28].…”

“…One study only included physical characteristics and another included physical characteristics and information about patient pathway [28,29]. Nine publications held information about physical characteristics [10,12,16,17,21,[24][25][26][27][28]. Six of the ten included studies were from Denmark [12,16,17,[24][25][26][27][28] One was from Sweden, Two from UK and one from the Netherlands [10,21,23,29].…”

“…Nine publications held information about physical characteristics [10,12,16,17,21,[24][25][26][27][28]. Six of the ten included studies were from Denmark [12,16,17,[24][25][26][27][28] One was from Sweden, Two from UK and one from the Netherlands [10,21,23,29]. The six studies from Denmark, the one from Sweden and the two from UK investigated patients with non-specific symptoms of cancer who were referred to a DC for further examination whereas the study from the Netherlands investigated GPs' gut feelings regarding cancer possibility [10,12,16,17,20,21,[23][24][25][26][27][28]32].…”

Economic impact of spectral body imaging in diagnosis of patients suspected for occult cancer

“…Several CPP iterations have been made, and in 2012, a new CPP for patients with non-specific symptoms of serious illness (NS-CPP) that could be cancer was implemented. The goal was an accelerated investigational course of no longer than 9 days to ensure relevant triage into either an organ-specific CPP or referral to relevant specialties to take care of treatment based on the diagnostic findings made during the workup [ 4 – 7 ].…”