Extensive Computed Tomography versus Limited Screening for Detection of Occult Cancer in Unprovoked Venous Thromboembolism: A Multicenter, Controlled, Randomized Clinical Trial

Paolo Prandoni; Enrico Bernardi; Fabio Dalla Valle; Adriana Visonà; Pietro F. Tropeano; Carlo Bova; Eugenio Bucherini; Md Shahidul Islam; Andrea Piccioli

doi:10.1055/s-0036-1592335

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2016; 42(08): 884-890
DOI: 10.1055/s-0036-1592335

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Extensive Computed Tomography versus Limited Screening for Detection of Occult Cancer in Unprovoked Venous Thromboembolism: A Multicenter, Controlled, Randomized Clinical Trial

Paolo Prandoni

¹Departments of Cardiovascular Sciences and Medicine, University Hospital of Padua, Padua, Italy

,

Enrico Bernardi

²Department of Emergency Medicine, Civic Hospital of Conegliano Veneto, ULSS 7 Pieve di Soligo, Italy

,

Fabio Dalla Valle

¹Departments of Cardiovascular Sciences and Medicine, University Hospital of Padua, Padua, Italy

,

Adriana Visonà

³Department of Internal and Vascular Medicine, Angiology Unit, Civic Hospital of Castelfranco Veneto, Italy

,

Pietro F. Tropeano

⁴Department of Emergency, Civic Hospital of Pordenone, Pordenone, Italy

,

Carlo Bova

⁵Department of Medicine, Civic Hospital of Cosenza, Cosenza, Italy

,

Eugenio Bucherini

⁶Department of Internal and Vascular Medicine, Angiology Unit, Civic Hospital of Faenza, Faenza, Italy

,

Md Shahidul Islam

⁷Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden

⁸Department of Internal Medicine and Emergency, Uppsala University Hospital, Uppsala, Sweden

,

Andrea Piccioli

¹Departments of Cardiovascular Sciences and Medicine, University Hospital of Padua, Padua, Italy

› Author Affiliations

Abstract

Patients with unprovoked venous thromboembolism (VTE) may harbor occult cancer. Whether an extensive diagnostic work-up for cancer has additional value over a more limited screening for detection of underlying malignancy in these patients is controversial. We performed a randomized multicenter trial to assess if in patients with unprovoked VTE, a computed tomography (CT)-based diagnostic strategy including thoracic, abdominal, and pelvic CT in combination with fecal occult blood test yields a higher cancer detection rate than a nonstandardized testing approach based on physicians' clinical judgment and patients' preferences. Cancer-free patients were followed up for up to 24 months. Of the 195 consecutive patients with unprovoked VTE who were eligible for this investigation, an occult cancer was identified in 10 of the 98 patients (10.2%) randomized to the CT-based strategy, and in 8 of the 97 (8.2%) allocated to the personalized strategy (absolute difference, 2.0%; 95% confidence interval, −7.2–11.1; p = 0.81). During follow-up, cancer was identified in an additional 2 patients in each group. Overall, 7 (7.1%) patients of the CT-based strategy died, as compared with 11 (11.3%) of the personalized strategy, with 2 and 4, respectively, due to cancer. In conclusion, a CT-based strategy in combination with fecal occult blood test does not provide a clinically significant benefit over more limited cancer screening for detecting occult cancer in patients with unprovoked VTE. (ClinicalTrials.gov number, NCT00361647).

Keywords

venous thromboembolism - cancer - diagnostic screening - computed tomography

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References

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