title: Investigation of unprovoked venous thromboembolism: a case for a tempered approach?
abstract: OBJECTIVE
  To investigate and review the diagnostic yield for occult malignancy in patients who underwent abdominopelvic computed tomography (CT) after the diagnosis of unprovoked venous thromboembolism (VTE) with reference to the guidelines set by The National Institute for Health and Clinical Excellence (NICE).
  
  
  METHODS
  We retrospectively reviewed all unprovoked VTE diagnosed within a large teaching hospital over a period of 21 months for subsequent imaging investigations and cancer diagnoses. The primary outcome was confirmed cancer diagnosis; patients were followed for a minimum of 12 months.
  
  
  RESULTS
  Three hundred and five unprovoked VTEs were diagnosed in the study period, 31% of all VTEs. Of this cohort, 73.1% underwent further imaging for exclusion of occult malignancy. Fifteen (4.9%) cancers were diagnosed; with no subsequent malignancy reported in a 12-month follow-up period of the remaining 290 patients. Of the 15 cancers, seven were post-pulmonary emboli, all of which were identified on the initial CT pulmonary angiogram, thus abdominopelvic CT only was used to locate the primary and to undertake staging. Eight were post-deep-vein thrombosis (DVT). Thus the diagnostic yield for malignancy on abdominopelvic CT post-unprovoked VTE was 2.3%. The majority of diagnosed cancers were advanced with 80% dying in the follow-up period with a mean survival of 3.4 months.
  
  
  CONCLUSIONS
  The pick-up rate of occult malignancy on abdominopelvic CT post-unprovoked VTE in the present study was 2.3%, far less than the generally quoted rate of 10%; however, similar to other rates in the literature. The benefit abdominopelvic CT brings to the diagnosis of occult malignancy post-unprovoked VTE is irresolute.
authors.affiliation: Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: T I
authors.initials: TI
authors.lastname: Hussain
authors.affiliation: Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK. Electronic address: James.Stephenson@uhl-tr.nhs.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Stephenson
authors.affiliation: Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: B
authors.initials: B
authors.lastname: Das
authors.affiliation: Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Naqvi
authors.affiliation: Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: R
authors.initials: R
authors.lastname: Verma
authors.affiliation: Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: D
authors.initials: D
authors.lastname: Barnes
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D010388:Pelvis / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000150:complications*; D055815:Young Adult