Extensive screening superior to limited screening in detecting Trousseau Syndrome

Patients with newly diagnosed venous thromboembolism may have a higher prevalence of previously undiagnosed cancer, but extensive screening may help identify more malignant cases.

Researchers at the University of Ottawa, the Ottawa Health Research Institute in Canada and the Brest University Hospital in France, conducted a meta-analysis of 36 studies, 14 articles and one abstract that analyzed extensive vs. limited cancer screening and undiagnosed cancer prevalence in patients with VTE.

The researchers reported a 6.1% prevalence of previously undiagnosed cancer in patients at baseline (95% CI, 5.0-7.1) and a prevalence of 10% from baseline to 12 months (95% CI, 8.6-11.3).

Limited screening detected 49.4% of previously undiagnosed cancers (95% CI, 40.2-58.5) in patients with newly diagnosed VTE, according to the researchers. Extensive screening that included CT of the abdomen and pelvis increased the proportion of previously undiagnosed cancers detected to 69.7% (95% CI, 61.1-77.8).

Based on their findings, the researchers concluded that extensive screening is superior to limited screening in the detection of more malignant cancers. – by Stacey L. Adams

Ann Intern Med. 2008;149:323-333.

This systematic review collates a great deal of literature on this important topic. In clinical practice, the question of when to screen for underlying cancer (as well as the value of screening) in a patient who presents with venous thromboembolism comes up relatively frequently. It is especially pertinent in patients who present with unexpected (‘idiopathic’) events.

It is unrealistic to perform extended screening for cancer in all patients with idiopathic venous thromboembolism, and we need to be able to define patients who fit a high-risk profile. This might, for example, include those without a family history of venous thrombosis, of more advanced age, and perhaps with persistently elevated D-dimers on warfarin therapy. The cost of applying malignancy screening to a select population may turn out to be a better use of resources than the widespread non-discriminate use of thrombophilia testing that is so often performed at present. However, the first trial that is needed is one in which it can be shown that earlier detection of cancer in this situation actually leads to improved outcomes. This may seem intuitive, but it does not necessarily follow that it will indeed be the case.

– Nigel Key, MD

HemOnc Today Editorial Board member