Work-up of patients with malignancy after an intermediate-probability ventilation-perfusion scan: why don't physicians pursue a definitive diagnosis?
OBJECTIVE
The authors determined whether there are specific patient characteristics associated with the clinical decision to eschew further diagnostic testing in patients in whom a ventilation-perfusion (V-P) scan indicates intermediate probability of pulmonary embolism (PE).


METHODS
The authors reviewed all intermediate-probability V-P scans obtained in a 12-month period. Patients were divided into two groups. Group 1 comprised patients in whom a definitive diagnosis of PE was not obtained and who were not treated for PE (n = 57); group 2 comprised patients in whom the diagnosis of PE was confirmed or excluded and who, if PE was confirmed, received appropriate treatment (n = 14). Age, gender, frequency of malignancy, and survival of patients in groups 1 and 2 were compared.


RESULTS
The frequency of malignancy was significantly greater in group 1 than in group 2 (P = .012). Although the estimated 2-year survival of group 1 patients was significantly less than that of group 2 patients (P = .039), this difference is likely due to confounding by age and malignancy.


CONCLUSIONS
When an intermediate-probability V-P scan is obtained, physicians are significantly less likely to pursue a definitive diagnosis of PE in patients with malignancy.
Rosen
M P
MP
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Rose
K
K
Davis
R B
RB
D000368:Aged; D000792:Angiography; D002423:Cause of Death; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011336:Probability; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography; D014692:Ventilation-Perfusion Ratio