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Int J Cancer ; 133(9): 2157-64, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23616232

ABSTRACT

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 (2-[F-18] fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography), a noninvasive 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%), with six of them at early stage. During follow-up, two 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 tissue factor (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.


Subject(s)
Blood Coagulation Factors/analysis , Early Detection of Cancer , Fluorodeoxyglucose F18 , Neoplasms, Unknown Primary/diagnosis , Positron-Emission Tomography , Tomography, X-Ray Computed , Venous Thromboembolism/complications , Aged , Anticoagulants/therapeutic use , Biomarkers, Tumor/blood , Female , Follow-Up Studies , Humans , Male , Neoplasms, Unknown Primary/etiology , Neoplasms, Unknown Primary/metabolism , Prognosis , Prospective Studies , Radiopharmaceuticals , Venous Thromboembolism/drug therapy
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