title: Reliability of diagnosing incidental pulmonary embolism in cancer patients.
abstract: BACKGROUND
  With the routine use of advanced multi-slice CT scanners, pulmonary embolism (PE) is increasingly detected as an incidental finding among cancer patients. Although this generally leads to therapeutic interventions, the accuracy of diagnosing PE on routinely performed contrast enhanced CT scans is unknown.
  
  
  METHODS
  Consecutive cancer patients diagnosed with incidental PE were eligible for inclusion. Their CT images were reassessed in a blinded fashion by two thoracic radiologists. To ensure blindness, a total of 19 cancer staging CT images without PE were included. The inter-observer reliability for the presence of PE was calculated with use of Kappa statistics.
  
  
  RESULTS
  A total of 62 incidental PE patients (mean age 64years, 60% male) were included. All patients received anticoagulant treatment upon diagnosis. Level of agreement between the two expert readers was high: they disagreed on the presence of PE in only two patients (3.2%), resulting in a Kappa statistic of 0.93. After final consensus reading, it was concluded that the CT images of all 62 patients initially diagnosed with incidental PE were indeed positive for PE.
  
  
  CONCLUSIONS
  This study indicates that an incidental PE diagnosis is reliable and highly reproducible, despite the suboptimal reading conditions of a non-dedicated scan protocol.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: p.l.den_exter@lumc.nl.
authors.forename: Paul L
authors.initials: PL
authors.lastname: den Exter
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van der Hulle
authors.affiliation: Department of Radiology, Maasstad Ziekenhuis Rotterdam, the Netherlands.
authors.forename: Ieneke J C
authors.initials: IJ
authors.lastname: Hartmann
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Cancer; Diagnosis; Pulmonary embolism; Reproducibility