Limited screening with versus without 18F-fluorodeoxyglucose PET/CT for occult malignancy in unprovoked venous thromboembolism: an open-label randomised controlled trial

Deep vein thrombosis

“…Up to 10% of DVT patients are subsequently diagnosed with a malignancy 1617. However, recent trials have found a low yield from screening for occult malignancy in patients with unprovoked DVT 18192021. NICE now recommends only a limited cancer screen in patients with unprovoked DVT (ie, history, examination, basic blood tests, and age appropriate national cancer screening investigation, eg, in UK, mammography in women who are 50 to 70) 12…”

Occult cancer screening in patients with venous thromboembolism: guidance from the SSC of the ISTH

“…In these studies, the limited screening strategy generally includes a thorough history and physical examination, blood work (complete blood count and differential blood count, electrolytes, creatinine, liver function tests, and lactate dehydrogenase), a chest X‐ray, and age‐specific and gender‐specific cancer screening, whereas an extensive screening strategy also includes one or more of computed tomography (CT) of the abdomen, pelvis, and thorax, ultrasound of the abdomen and pelvis, endoscopy, mammography and/or serum tumor markers, and, more recently, positron emission tomography–CT. Although all studies showed that a more extensive screening strategy did not detect more occult cancer than a more limited strategy, two studies suggested that an extensive screening strategy might detect earlier‐stage tumors and be associated with a lower number of newly diagnosed cancers (or fewer occult cancers being missed) during follow‐up . Nonetheless, it remains unclear whether these findings translate into an improvement in patient‐important outcomes, including a decrease in morbidity or an increase in survival, in this patient population.…”

Should we screen extensively for cancer after unprovoked venous thrombosis?

“…3 The intervention group had, in addition, comprehensive fludeoxyglucose ( 18 F) positron emission tomography and computed tomography. Occult cancer was diagnosed in 15 patients with an incidence of 3.81%.…”