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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months

Research output: Contribution to journalJournal articleResearchpeer-review

  • Marie Møller
  • Bue Juvik
  • Stine Chabert Olesen
  • Hanne Sandstrøm
  • Erling Laxafoss
  • Simon Bertram Reuter
  • Uffe Bodtger
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OBJECTIVES: To describe the diagnostic properties of thoracoabdominal contrast-enhanced CT (ceCT), when general practitioners (GPs) managed referral to ceCT through the non-specific symptoms or signs of cancer-cancer patient pathway (NSSC-CPP).

DESIGN: Retrospective cohort study including patients from a part of Denmark.

SETTING: Department of Internal Medicine at a university hospital.

PARTICIPANTS: In total, 529 patients underwent ceCT.

PRIMARY AND SECONDARY OUTCOMES: Our primary objective was to estimate the negative and positive likelihood ratios for being diagnosed with cancer within 1 year after ceCT. Our secondary outcomes were prevalence and final diagnoses of malignancy (including temporal trends since implementation of NSSC-CPP in 2012), the prevalence of revision of CT scans and referral patterns based on ceCT results.

RESULTS: In total, 529 subjects underwent ceCT and malignancy was identified in 104 (19.7%) patients; 101 (97.1%) during initial workup and 3 patients during the subsequent 12 months follow-up.Eleven patients had a false-negative ceCT, and revision classified the ceCT as 'probable/possible malignancy' in eight (73%) patients. The negative predictive value was 98% and positive predictive value 63%. Negative and positive likelihood ratios for malignancy was 0.1 and 7.9, respectively.

CONCLUSION: Our study shows that ceCT as part of GP-coordinated workup has a low negative likelihood ratio for identifying malignancy; this is important since identifying patients for further workup is vital.

Original languageEnglish
JournalBMJ Open
Volume9
Issue number12
Pages (from-to)e032019
ISSN2044-6055
DOIs
Publication statusPublished - 31 Dec 2019

ID: 59373442