SPC365

Abdominopelvic CT for cancer screening in patients with unprovoked pulmonary embolism - a closed discussion?

Session: Comunicações Orais - Sessão 10 - Hipertensão Pulmonar Tromboembólica Crónica
Speaker: Diogo Rosa Ferreira

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Diogo Rosa Ferreira; Beatriz Silva; Joana Brito; Pedro Alves da Silva; Beatriz Garcia; Ana Margarida Martins; Catarina Oliveira; Miguel Raposo; Catarina Gregório; Ana Abrantes; Miguel Nobre Menezes; Andreia Magalhães; Manuela Fiuza; Rui Plácido; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><strong>INTRODUCTION</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">: Pulmonary embolism (PE) may be the earliest sign of cancer. Early diagnosis of malignancy leads to improved overall survival. ESC guidelines suggest a focused clinical assessment before proceeding to abdominopelvic computed tomography (CT) in patients with an unprovoked PE. However, there is insufficient evidence to draw conclusions on the effectiveness of screening for occult malignancy in these patients (pts). Our study aimed to establish whether routine abdominopelvic CT allowed earlier malignancy diagnosis and improved outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff"><strong>METHODS</strong></span></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff">: Retrospectively single-center study of pts admitted with PE diagnosis established by CT pulmonary angiogram and without a previous diagnosis of cancer, from 2019 to 2020. Clinical records were examined to establish whether routine </span></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">abdominopelvic </span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff">CT increased the detection rate of underlying malignancy.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><strong>RESULTS</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">:</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff"> A total of </span></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">253</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff"> pts with PE diagnosis and no previous history of malignancy were included (</span></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">42%</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><span style="background-color:#ffffff"> male; mean age 68 years). Eighty-nine (35%) pts underwent </span></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">abdominopelvic CT in order to exclude malignancy (of those, 87% performed the exam during the current hospitalization). Extended screening for malignancy was associated with a significantly longer hospital stay (13 </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#222222">&plusmn;</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"> 14 vs 7 </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#222222">&plusmn;</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"> 8 days, p&lt;0.001). Anaemia or thrombocytopenia did not influence the decision for screening (p=0.625).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">Thirteen out of 89 had evidence of malignancy on abdominopelvic CT (diagnostic profitability of 14%). The most diagnosed primary tumours were colorectal (39%), lung (15%) and ovarian (15%). About half of patients (54%) were diagnosed on stage IV (metastatic), 3 pts (23%) on stage III, and 1 patient for stages I and II.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">In the subgroup of pts in which malignancy screening was not performed, 7 pts (4%) were diagnosed with cancer during the follow-up (mean time difference between PE and diagnosis of 16 </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#222222">&plusmn;</span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"> 7 months). Of those, 2 pts were diagnosed in stage IV and 3 pts in stage III.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">There was no difference in all-cause mortality between the group of patients who were submitted to routine abdominopelvic CT after unprovoked PE and those who were not (p=0.145).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222"><strong>CONCLUSION</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">:&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:#222222">We found that the prevalence of occult cancer was high among pts with a first unprovoked PE. Even though routine abdominopelvic CT helps in the diagnosis of underlying malignancy it does so at advanced stages and does not provide a significant reduction in overall mortality.</span></span></span></p>

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