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Patients with SLE, multiple CT scans may have a higher risk for malignancy
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Patients with systemic lupus erythematosus with chest pain may undergo multiple CT scans for pulmonary embolism, and while multiple scans were associated with a lower likelihood of positive results and a higher risk for malignancy, researchers suggest the magnitude of risk should not discourage the use of CT when clinically indicated.
Researchers studied data from 764 women and 90 men with systemic lupus erythematosus (SLE) who satisfied at least four American College of Rheumatology criteria for SLE. Pulmonary embolism (PE) CT scans were performed 365 times for 182 patients. Eight scans were indeterminate and not included in the analysis.
Overall, the rate of PE as 7.5%, or observed in 27 of 357 scans, while the rate of positive scans for PE declined with additional scans after the first through third scans (8.8% positive). A positive result for PE was observed in 1.6% of the fourth through tenth scans. An increased risk for breast cancer of 0% to 0.1% was observed for 64.19% of women (95 of 148 patients), an increased risk of 0.1% to 0.5% was observed in 31.76% of women (47 of 165) and an increased risk of 0.5% to 1% was observed in 4.05% of women in the study. An increased risk for lung cancer of 0% to 0.1% was observed in 51.35% of patients, an increased risk of 0.1% to 0.5% was observed in 47.3% of patients and an increased risk of 0.5% to 1% was observed in 1.35% of patients.
“Our data show a significantly decreased likelihood of a positive result with PE CT in patients who had three or more previous PE CT scans,” the researchers wrote. “The higher risk of a positive result in patients who have had fewer previous scans could be related to clinical characteristics that tend to improve with longer disease duration in SLE patients, such as proteinuria, disease activity, lipid profile and smoking cessation, or longer duration of administration of antimalarial drugs that reduce thrombotic risk, or successful anticoagulation use by patients with positive scans.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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