Has this patient a cancer? The assessment of weight loss, anemia and erythrocyte sedimentation rate as diagnostic tests in cancer. A retrospective study based in a secondary care university hospital in Romania.
BACKGROUND
"Has this patient a cancer?" is a question we frequently ask ourselves in front of some symptoms, signs or laboratory results like weight loss, anemia and high erythrocyte sedimentation rate (ESR). The aim of this study is to assess their value in the diagnosis of cancer.


METHODS
A retrospective study of the records of 5500 patients admitted in the Department of Internal Medicine during the 1998 January-September period has been performed, selecting those patients with weight loss, anemia (Hb < 10.5g/dl) and ESR > = 50 mm/h.


RESULTS
The three diagnostic tests (anemia, high ESR and weight loss) had a low sensitivity (37, 52 and 46%, respectively), but a good specificity (92, 89 and 94%, respectively). For a 4% prevalence of cancer, as seen in our group, the resulting negative predictive value for the three tests was estimated respectively at 97, 98 and 98%, the post-test probabilities being estimated at 3, 2.2% in the case of negative tests. For a parallel utilisation of the tests, the sensitivity was 87%, the specificity 79%, the positive predictive value 15% and the negative predictive value 99%, the post-test probability in the case of a negative test being 1% [LR(-) = 0.17]; for serial utilisation, the specificity grew at 99.6% (CI: 99-100%), the positive predictive value (as the post-test probability in the case of a positive test) being 51% (CI: 50-53%) [LR(+) = 24.62].


CONCLUSIONS
Any patient admitted in our department of Internal medicine has a 4% probability of having a cancer. Among those with weight loss, anemia and high ESR, one patient out of two has a cancer; among those with weight loss and anemia, 44% have a cancer; and among those with weight loss and high ESR, one out of three has a cancer.
Băicuş
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C
Department of Internal Medicine, "N. Gh. Lupu" Hospital, Sos. Stefan cel Mare 19-21, sect. 2, 72202 Bucharest, Romania. cbaicus@yahoo.com
Tănăsescu
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C
Ionescu
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R
D000740:Anemia; D001799:Blood Sedimentation; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012383:Romania; D012680:Sensitivity and Specificity; D015431:Weight Loss