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

Marie Møller, Bue Juvik, Stine Chabert Olesen, Hanne Sandstrøm, Erling Laxafoss, Simon Bertram Reuter, Uffe Bodtger

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Abstract

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
Article numbere032019
JournalBMJ Open
Volume9
Issue number12
Number of pages7
ISSN2044-6055
DOIs
Publication statusPublished - 31. Dec 2019

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General Practitioners
Cohort Studies
Referral and Consultation
Retrospective Studies
Neoplasms
Denmark
Internal Medicine

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Cite this

@article{976b5d3c06f6481f9c4f156e249d712b,
title = "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",
abstract = "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.",
author = "Marie M{\o}ller and Bue Juvik and Olesen, {Stine Chabert} and Hanne Sandstr{\o}m and Erling Laxafoss and Reuter, {Simon Bertram} and Uffe Bodtger",
note = "{\circledC} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = "12",
day = "31",
doi = "10.1136/bmjopen-2019-032019",
language = "English",
volume = "9",
journal = "B M J Open",
issn = "2044-6055",
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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. / Møller, Marie; Juvik, Bue; Olesen, Stine Chabert; Sandstrøm, Hanne; Laxafoss, Erling; Reuter, Simon Bertram; Bodtger, Uffe.

In: BMJ Open, Vol. 9, No. 12, e032019, 31.12.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - 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

T2 - a retrospective cohort study on cancer prevalence after 12 months

AU - Møller, Marie

AU - Juvik, Bue

AU - Olesen, Stine Chabert

AU - Sandstrøm, Hanne

AU - Laxafoss, Erling

AU - Reuter, Simon Bertram

AU - Bodtger, Uffe

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/12/31

Y1 - 2019/12/31

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2019-032019

DO - 10.1136/bmjopen-2019-032019

M3 - Journal article

C2 - 31892651

VL - 9

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 12

M1 - e032019

ER -