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DOI: 10.1055/s-2008-1027994
© Georg Thieme Verlag KG Stuttgart · New York
Do We Need a Cancer Screening in Patients with Idiopathic Deep Vein Thrombosis?
Ist ein Tumor- Screening bei Patienten mit idiopathischer tiefer Venenthrombose nötig?Publication History
received: 6.5.2008
accepted: 23.10.2008
Publication Date:
28 January 2009 (online)

Zusammenfassung
Ziel: Eine Revision der Fachliteratur bezüglich des Bedarfs für ein Tumor-Screening zur Diagnose von nicht erkannten Tumorerkrankungen bei Patienten mit idiopathischer tiefer venöser Thromboembolie (VTE). Materialien und Methode: In der Studie wurden Daten von computergestützten Datenbanken (Medline, Ovid) bezogen und die Fachliteratur bezüglich der Studien über das Tumor-Screening bei Patienten mit idiopathischer VTE ausgewertet und unsere eigene Verfahrensweise hinzugefügt. Ergebnisse: Patienten mit einer VTE hatten eine höhere Malignitätsrate auch bei noch nicht diagnostizierten Tumoren. Bei den Nachkontrollen von Patienten mit VTE stieg das Vorkommen von Tumorerkrankungen und wurde gleichzeitig mit einer Verschlechterung der Prognose verbunden. Eine bedingte Diagnostik bei Patienten mit idiopathischer VTE ermöglicht die Diagnose von verborgenen Tumorleiden in ungefähr der Hälfte der untersuchten Fälle mit einer Sensitivität von 48 %. Ein ausführliches Tumor- Screening bei idiopathischer VTE dagegen führte zu weniger Zeitverzögerung und früherer Diagnose des Tumors mit einer Sensitivität von 93%. Eine erniedrigte tumorbedingte Sterblichkeit erwies sich bei diesen Patienten jedoch nicht als statistisch signifikant. Im Vergleich mit Patienten ohne einem Tumorleiden war bei Patienten mit VTE und nicht erkanntem Tumorleiden die Wahrscheinlichkeit einer tödlichen Lungenembolie war auf das Doppelte, die einer fatalen Blutung auf mehr als das Dreifache erhöht. Die Risikofaktoren für nicht erkannte Tumorleiden sind: hohes Alter, Anämie, idiopathische und beidseitige tiefe Venenthrombosen. Schlussfolgerungen: Es besteht kein Konsens bezüglich der Vorteile eines ausgedehnten Screenings bei Patienten mit einer idiopathischen VTE. Klare diagnostische Richtlinien bestehen noch nicht. Eine kosteneffektiver diagnostischer Algorhythmus für ein Tumor -Screening bei Patienten mit idiopathischer VTE ist erforderlich.
Abstract
Aim: To review the literature concerning the need for a cancer screening battery to diagnose a hidden cancer in patients presenting with idiopathic venous thromboembolism (VTE). Materials and Methods: Data from computerized database programs (Medline, Ovid) was retrieved. A review of the literature regarding studies on cancer screening in patients with idiopathic VTE was performed and our own policy included. Results: Patients with VTE have a higher rate of malignancy which may still be undiagnosed. During follow-up of patients with idiopathic VTE, the incidence of cancer increases and is more likely associated with a worse prognosis. Limited diagnostic work-up in patients with idiopathic VTE allows the diagnosis of a hidden malignancy in about half of the cases with a sensitivity of 48 %. Extensive screening of cancer with idiopathic VTE allows less of a delay and earlier stage at diagnosis with a 93 % sensitivity. However, reduced cancer-related mortality is not statistically significant. A two-fold fatal PE and more than 3-fold fatal bleeding are registered in VTE patients with hidden cancer compared to patients without cancer. The major risk factors for hidden cancer are old age, anemia, idiopathic and bilateral deep vein thrombosis. Conclusion: There is no consensus regarding the benefit of extensive screening in patients presenting with idiopathic VTE. Clear diagnostic work-up guidelines are not yet available. A cost-effective diagnostic algorithm for cancer screening in patients with idiopathic VTE is needed.
Key words
veins - diagnostic radiology - screening - tumor - ultrasound Doppler
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Dr. Diana E Gaitini
Radiology, Rambam Medical Center
Hahalya Hasnia 8
31096 Haifa
Israel
Phone: ++ 9 72/4/8 54 36 75
Fax: ++ 9 72/4/8 54 33 03
Email: d_gaitini@rambam.health.gov.il