Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients.
OBJECTIVE
To identify potential risk factors and the yield of routine screens for early detection of malignancy associated with dermatomyositis (DM) and polymyositis (PM).


METHODS
Retrospective study of malignancies in all patients with DM or PM followed up between the years 1981 and 2000 and a review of the relationship of DM and PM to malignancy, the usefulness of various tests or examinations for malignancy search, and the patients' course.


METHODS
Departments of internal medicine and dermatology in a teaching hospital.


METHODS
Forty consecutive adult patients with DM (33 cases) or PM (7 cases).


METHODS
(1) Rate of false-negative results of routine workup and yield (percentage of positive results) of blind malignancy search and (2) comparison of 16 characteristics in patients with malignancy vs those without.


RESULTS
Malignancy occurred in 16 patients: 13 with DM and 3 with PM. In all cases, the diagnosis of malignancy was made concurrently with or shortly after the diagnosis of DM or PM. Factors associated with malignancy were recruitment in the internal medicine department (P =.02), constitutional symptoms (P<.01), a rapid onset of DM or PM (P =.02), the lack of Raynaud phenomenon (P<.01), and a higher mean erythrocyte sedimentation rate (P<.01) and creatine kinase level (P<.01). Initial routine search failed to discover 4 malignancies, 3 of which were discovered at an advanced stage by more extensive investigations. The positive result yield of blind malignancy search was only 13% (11 of 87), but reached 28% (5 of 18) for blind abdominal-pelvic and thoracic computed tomographic scans.


CONCLUSIONS
Extensive search for malignancy, particularly computed tomographic scans, may be warranted in at least a subset of patients with DM or PM and risk factors of malignancy.
Sparsa
Agnès
A
Department of Dermatology, University Hospital of Limoges, Limoges, France.
Liozon
Eric
E
Herrmann
François
F
Ly
Kim
K
Lebrun
Valérie
V
Soria
Pascale
P
Loustaud-Ratti
Véronique
V
Bouyssou-Gauthier
Marie-Laure
ML
Boulinguez
Serge
S
Bédane
Christophe
C
Jauberteau
Marie-Odile
MO
Vidal
Elisabeth
E
Bonnetblanc
Jean-Marie
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D015897:Comorbidity; D003402:Creatine Kinase / Q000097:blood; D003430:Cross-Sectional Studies; D003882:Dermatomyositis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D010348:Patient Care Team; D017285:Polymyositis / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011928:Raynaud Disease / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D003402:Creatine Kinase