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“Incidence of Occult Malignancy Diagnosed in Patients With Unprovoked Pulmonary Embolism” 
Poster Title: “Incidence of Occult Malignancy Diagnosed in Patients With Unprovoked Pulmonary Embolism” 
Submitted on 26 Sep 2019
Author(s): Dr Fatma Eminaga, Dr Reema Akhter, Dr Sridhar Radla
Affiliations: Princess Alexandra Hospital
This poster was presented at British Institute of Radiology Annual Congress
Poster Views: 695
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Poster Information
An unprovoked VTE episode carries a higher incidence of new cancer diagnosis, compared to the rest of the population. In some cases, a VTE event is the first clinical manifestation of an occult malignancy.

Diagnosis of an underlying cancer is critical to the optimal VTE management as well as early treatment of the cancer and is cost effective.

National Institute for Health Care Excellence (NICE) guidelines recommend that all patients diagnosed with unprovoked VTE should undergo screening for cancer. This includes CT abdomen/pelvis (CT AP) and mammography for patients over 40.

To the best of our knowledge, there is no previous study investigating the incidence of malignancy found solely by CT AP as part of the screening following an unprovoked PE.

To evaluate the incidence of occult malignancies diagnosed with a CT AP following an episode of an unprovoked PE as part of the screening process.

We retrospectively analysed the radiology database in our hospital, over a 4-year period, and identified all “CT AP” referrals containing the word “unprovoked” in the clinical information.

124 eligible cases of unprovoked PE were identified, with an age range of 30-96.

8 out of 125 patients (6.4%) with unprovoked PE were found to have an abnormal CT AP which eventually led to the diagnosis of a malignancy.
Mean interval between the diagnosis of the PE and CT AP was 7 days.


The results of this study highlight the role of targeted screening for occult malignancy in patients with first presentation of an unprovoked PE.
Summary: Incidence of occult malignancy diagnosed in patients with unprovoked pulmonary embolismReferences: 1. Alfonso, A., Redondo, M., Rubio, T., Del Olmo, B., et al. (2013) Screening for occult malignancy with FDG-PET/CT in patients with unprovoked venous thromboembolism. International Journal of Cancer. [Online] 133 (9), 2157–2164. Available from: doi:10.1002/ijc.28229.

2. Abdol Razak, N., Jones, G., Bhandari, M., Berndt, M., et al. (2018) CancerAssociated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers. [Online] 10 (10), 380. Available from: doi:10.3390/cancers10100380.

3. National Clinical Guideline Centre (UK). Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet]. London: Royal College of Physicians (UK); 2012 Jun. (NICE Clinical Guidelines, No. 144.) 13, Investigations for cancer in VTE patients.

4. Lima, L.G. & Monteiro, R.Q. (2013) Activation of blood coagulation in cancer: implications for tumour progression. Bioscience Reports. [Online] 33 (5), 701–7
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