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BACKGROUND: Patients with non-specific symptoms or signs of cancer (NSSC) present a challenge as they are a heterogeneous population who are not candidates for fast-track work-up in an organ-specific cancer pre-planned pathway (CPP). Denmark has a cancer pre-planned pathway for this population (NSSC-CPP), but several issues remain unclarified, for example, distribution and significance of symptoms and findings, and choice of imaging. AIM: To investigate symptoms, cancer diagnoses, and diagnostic yield of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients on NSSC-CPP to improve the overall diagnostic process. DESIGN & SETTING: A retrospective medical chart review in a 1-year consecutive cohort (2020). METHOD: A total of 802 referrals were reviewed for diagnostic imaging in patients with NSSP from general practices, specialist practices, or the local hospital diagnostic centre responsible for NSSC-CPP. RESULTS: The study included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity of 85%, specificity of 87%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 96%. For 18F-FDG-PET/CT, the numbers were sensitivity 82%, specificity 62%, PPV 33%, and NPV 94%. Patients frequently underwent subsequent examinations following initial imaging. CONCLUSION: The findings were in accordance with the literature. Patients with NSSC had a cancer prevalence of 21%, most frequently gastrointestinal. The most frequent symptom was weight loss and, even as the only symptom, it is a potential marker for cancer. CT and 18F-FDG-PET/CT were sensitive with high NPV, whereas PPV was superior in CT. Better stratification by symptoms or findings is an obvious focus point for future studies to further optimise the NSSC-CPP work-up strategy.
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INTRODUCTION Use of an urgent fast-track pathway comprising contrast-enhanced computed tomography (CECT) is a recognised method for diagnostic evaluation of patients with non-specific symptoms. This study focused on a subgroup of patients with non-specific symptoms who are diagnosed outside of fast-track pathways. To investigate the cancer prevalence in patients with non-specific symptoms outside of fast-track pathways undergoing a thoracoabdominal CECT. METHODSThis was a retrospective observational study including patients referred for a thoracoabdominal CECT. Patients with non-specified symptoms were included. All pathology reports were reviewed to confirm histopathological findings. Data were collected during a one-year period from the Department of Radiology, Vejle Hospital. RESULTS A total of 238 patients were included; 125 (52.5%) women and 113 (47.5%) men. The median age was 69 years (range: 29-99 years). Fifty (21%) patients (25 men and 25 women) were diagnosed with malignant conditions by computed tomography (CT), all of which were confirmed by biopsy (median age = 68 years, range: 43-87 years). An additional ten patients had CT findings consistent with malignancies that were not confirmed by biopsy (median age = 86 years, range: 58-93 years). CONCLUSION We found a 21% prevalence of cancer. FUNDING none. TRIAL REGISTRATION not relevant.