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Incidence of malignancy detected on abdomino-pelvic CT following an unprovoked VTE: Are we over-investigating?
EP29257
Incidence of malignancy detected on abdomino-pelvic CT following an unprovoked VTE: Are we over-investigating?
Submitted on 01 Oct 2018

Dr R Aziz, Dr F U Chowdhury, Dr S Vaidyanathan
Leeds Teaching Hospitals
This poster was presented at BIR Annual Congress 2018
Poster Views: 261
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Poster Abstract
Background:



There is an established 3-10 fold increased risk of VTE in cancer, and the occurrence of cancer-related VTE leads to a poorer prognosis overall. Hence the need for these to be picked up.



NICE guidelines recommends CT abdomen/pelvis in those >40yrs with an unprovoked VTE who do not have signs or symptoms of cancer after initial investigations.



Aim:

1. To analyse the positive pick-up rate for malignancy on CT-AP following an unprovoked VTE.

As this is a re-audit since 2014, the following secondary aims were also included:

2. Compare referral rates since previous audit.

3. Identify age of patient's referred.

4. Identify associated factors/clinical symptoms/signs predictive of malignancy.





Methods



A CRIS data extraction was performed retrospectively between 01/06/14- 31/08/17 at Leeds teaching Hospitals.



Initial patient search yielded 1048, 370 of which fit the inclusion criteria.





Results



Of the 370 scans performed for unprovoked VTE events, 16 had clinically 'significant' findings. 4 of these were confirmed cancers and 12 were otherwise benign findings.



Results showed that scans performed for unprovoked VTEs had doubled since the previous audit. 16 of the scans were in patients <40yrs, which falls outwith NICE guidelines.



From the 4 confirmed cancers, all patients exhibited clear clinical signs and symptoms.



Conclusions

This re-audit reinforces the importance of having clinical red flags before considering a CT AP in those with unprovoked VTE.
Over-investigation of those <40yrs
Scan requests and therefore costs have doubled since 2014.


Recommendations:

Unprovoked VTE algorithm devised for clinicians and vetting radiologists.

1. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Clinical guideline [CG144] Published date: June 2012 Last updated: November 2015

2. Carrier M, et al. Screening for occult cancer in unprovoked venous thromboembolism. NEJM 2015;373:8.
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