Clinical Question

Is routine computed tomography (CT) of the abdomen and pelvis helpful in patients with an initial unprovoked episode of venous thromboembolism (VTE)?

Bottom Line

There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE. (Level of Evidence = 1b)

Synopsis

Patients with an unprovoked episode of deep venous thrombosis (DVT) or pulmonary embolism (PE) are at increased risk of occult malignancy. However, the best approach to evaluate patients for cancer is unclear. In this trial, adults with a first diagnosis of an episode of DVT or PE at one of nine Canadian centers were randomized to receive either a basic evaluation for occult malignancy (history and physical, basic blood tests, chest radiography, mammography for women older than 50 years, a Papanicolaou test for sexually active women 18 to 70 years of age, and prostate cancer screening for men older than 40 years) or the same evaluation plus comprehensive CT of the abdomen and pelvis. Patients with impaired renal function or allergy to contrast media, and those who could not easily comply with a CT scan, were excluded. A total of 3,186 patients were evaluated for eligibility, 862 were randomized, and 854 were included in the intention-to-treat analysis. The mean age of the included patients was 53 years; 67% had a DVT, 33% had a PE, and 12% had both. Overall, 33 patients (3.9%) had a new diagnosis of cancer during the first year of follow-up: 14 in the basic screening group, and 19 in the group that also received a CT scan. The mean time to a new cancer diagnosis was 4.2 months for the patients who received basic screening, and four months for those who also received CT.

Study design: Randomized controlled trial (single-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: CarrierMLazo-LangnerAShivakumarSet alSOME InvestigatorsScreening for occult cancer in unprovoked venous thromboembolism. N Engl J Med2015; 373( 8): 697– 704.