Screening for occult malignancy with FDG-PET/CT in patients with unprovoked venous thromboembolism

Autores: Alfonso Piérola, Ana; Redondo Izal, Margarita; Rubio Vela, Tomás; Del Olmo Huici, Beatriz; Rodríguez Wilhelmi, Pablo; García Velloso, María José; Richter Echevarría, José Ángel; Páramo Fernández, José Antonio; Lecumberri Villamediana, Ramón
ISSN: 0020-7136
Volumen: 133
Número: 9
Páginas: 2157-2164
Fecha de publicación: 2013
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 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. 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). FDG-PET/CT is feasible for the screening of occult cancer in patients with unprovoked VTE, showing high S and NPV.