title: Diagnosing pulmonary embolism: experience with spiral CT pulmonary angiography in gynecologic oncology.
abstract: OBJECTIVE
  To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients.
  
  
  METHODS
  Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patients were collected from our radiology database from 6/2001 to 6/2003. Patient charts were retrospectively reviewed. Data were abstracted relative to presenting symptoms, demographics and laboratory and diagnostic evaluations. Patient data were compared using chi-square contingency tables and logistic regression analysis. Survival was studied using the Kaplan-Meier method and the log rank test. The effect of PE on survival was adjusted using a proportional hazards regression model.
  
  
  RESULTS
  One-hundred and eleven CTPA studies were performed over 2 years and 25 patients were diagnosed with PE. Both PE (n = 25) and non-PE (n = 86) groups were similar for age, race, BMI and cancer diagnosis. Tachycardia (P = 0.02, OR = 3.03 [95% CI 1.16-7.94]) and leukocytosis (P = 0.04, OR = 2.93[95% CI 1.05-8.18]) were more frequent among PE patients and confirmed as independently prognostic of PE. All other clinical and laboratory findings were similar between patients with and without PE. Overall survival for patients with and without PE was 63% versus 94%, respectively, at 2 years (P = 0.02).
  
  
  CONCLUSIONS
  In a gynecologic oncology patient with high clinical suspicion for PE, our clinical pre-test probability was 23.0%. Two-year mortality rates were 6-fold higher for patients diagnosed with PE. The significant overlap in clinical presentations, multiple risk factors and higher mortality rates encourage the aggressive diagnosis and treatment of PE among this population. Further work is needed to reduce the incidence and mortality rate of PE.
authors.affiliation: Division of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612, USA. mmartino@hsc.usf.edu
authors.forename: Martin A
authors.initials: MA
authors.lastname: Martino
authors.forename: Eva
authors.initials: E
authors.lastname: Williamson
authors.forename: Sylvia
authors.initials: S
authors.lastname: Siegfried
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cardosi
authors.forename: Alan B
authors.initials: AB
authors.lastname: Cantor
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Hoffman
authors.forename: James V
authors.initials: JV
authors.lastname: Fiorica
mesh_terms: D000792:Angiography / Q000379:methods; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D015996:Survival Rate; D036542:Tomography, Spiral Computed / Q000379:methods