Use of ultrasonography to screen for occult cancer in patients with idiopathic venous thrombosis

Abstract

Background: Patients with idiopathic deep vein thrombosis have a high enough incidence of cancer to justify an investigation of underlying malignant disorders. Aim: This study aimed to retrospectively analyze pelvic and abdominal ultrasound as a screening method for occult cancer in patients with idiopathic deep vein hrombosis.
Method: The medical records of 120 individuals diagnosed with idiopathic deep vein thrombosis, who had been submitted to pelvic and abdominal ultrasound at admission or within 30 days after discharge, were evaluated. Results: Malignancies were confirmed by histopathological analysis in 4 patients after abnormalities suggestive of neoplasms had been identified in the examination. Four other patients without any changes at ultrasound had malignancies diagnosed by other methods. Conclusion: Ultrasonography to screen for abdominal occult cancer in patients with idiopathic venous thrombosis is recommended

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USE OF ULTRASONOGRAPHY TO SCREEN FOR OCCULT CANCER IN PATIENTS WITH IDIO-
PATHIC VENOUS THROMBOSIS
JOSÉ MARIA PEREIRA DE GODOY*, ANDRÉ LUÍS COZETTO DE OLIVEIRA**, ANDRESSA RIBEIRO**, FERNANDO BATIG ÁLI A ***
*Department Cardiology and Cardiovascular Surgery in Medicine School in São José do Rio Preto-FAMERP, professor of the
Graduation and Post-graduation courses (Stricto-Sensu) in FAMERP-Brazil - **Resident in Medicine School in Sao Jose do Rio
Preto-FAMERP-Brazil - ***Department of Anatomy in Medicine School in São José do Rio Preto-FAMERP-Brazil
Introduction
Patients who suffer from idiopathic Deep Vein
Thrombosis (DVT) have a sufficiently high inci-
dence of cancer (4.6% to 25%), to justify an inves-
tigation of underlying malignant disorders(1-5).
On considering all patients with cancer, those
with DVT have a significant reduction in survival
rates with a four - to eight-fold higher risk of death
being reported(6). The diagnosis of occult malignan-
cies in patients with idiopathic DVT by screening
using different tests, including abdominal and
pelvic ultrasonography, was approximately 13%.
These patients were diagnosed at an early stage.
The diagnosis of occult malignancies in
patients with idiopathic DVT by screening using
different tests, including abdominal and pelvic
ultrasonography, was approximately 13%. These
patients were diagnosed at an early stage. On the
other hand, where individuals are not investigated
for possible malignancies after the thrombotic
event, 9.8% were symptomatic within a period of 2
years and more advanced cancer was diagnosed
compared to those who are submitted to screen-
ing(7).
However, the use of ultrasound in screening is
still controversial(3).
This study aimed to retrospectively analyze
the use of pelvic and abdominal ultrasound as a
screening method for occult cancer in patients who
suffer from idiopathic DVT.
Method
The hospital records of 500 patients with diag-
nosis of DVT hospitalized in Hospital de Base
Medicine School, São José do Rio Preto in the peri-
od from January 2005 to March 2010 were evaluat-
ed. The inclusion criteria were the diagnosis of
idiopathic DVT and performing abdominal ultra-
sonography, as shown in Figure 1, during the hospi-
tal stay or within 30 days of discharge.
Acta Medica Mediterranea, 2013, 29: 451
ABSTRACT
Background: Patients with idiopathic deep vein thrombosis have a high enough incidence of cancer to justify an investiga-
tion of underlying malignant disorders.
Aim: This study aimed to retrospectively analyze pelvic and abdominal ultrasound as a screening method for occult cancer in
patients with idiopathic deep vein thrombosis.
Method: The medical records of 120 individuals diagnosed with idiopathic deep vein thrombosis, who had been submitted to
pelvic and abdominal ultrasound at admission or within 30 days after discharge, were evaluated. Results: Malignancies were con-
firmed by histopathological analysis in 4 patients after abnormalities suggestive of neoplasms had been identified in the examina-
tion. Four other patients without any changes at ultrasound had malignancies diagnosed by other methods.
Conclusion: Ultrasonography to screen for abdominal occult cancer in patients with idiopathic venous thrombosis is recom-
mended.
Key words: Venous Thrombosis, Mass Screening, Cancer.
Received April 11, 2013; Accepted May 12, 2013

452 José Maria Pereira de Godoy*, André Luís Cozetto de Oliveira et Al
Patients diagnosed with cancer and those who
had previously suffered from DVT were excluded.
The study was approved by the Research
Ethics Committee of the Medicine School in Sao
José do Rio Preto. The data were analyzed by
descriptive statistics analysis.
Results
One hundred and twenty individuals (66
female and 54 male) diagnosed with idiopathic
DVT were enrolled in this study (mean age: 58.9
years old).
Malignancies were confirmed in 4(3,3%)
patients by histopathological analysis after suspi-
cious changes seen at ultrasound: abdominal mass
in the topography of the head of the pancreas 1-
(0,83%) with confirmed pancreatic cancer, renal
mass (1) with histopathologic diagnosis of papillary
renal cell carcinoma, rectosigmoid wall thickening
with obliteration of adjacent fat (1), where further
investigation showed the presence of colorectal
cancer, and abdominal mass in right iliac fossa
involving the iliac arteries and liver implants (1),
revealing the presence of malignant neoplasms of
undetermined origin.
Four (3,3%)other patients in this group with-
out changes in the ultrasound exams were diag-
nosed with colorectal (2), esophageal (1) and
parotid (1) cancer.
Discussion
This study shows that abdominal and pelvic
ultrasound was useful in screening for cancers in
patients with idiopathic DVT. Eight (6.7%) patients
with occult malignancies associated with idiopathic
DVT were detected by early screening using several
diagnostic methods including ultrasound screening.
Thus, 50% of these cases had abnormal ultra-
sound examinations with malignancies.
The diagnosis of neoplasms after acute
episodes of DVT, according to the literature, occurs
when the cancer is in an early stage in 61% of
patients submitted to screening compared to 14% of
those who choose a wait and watch approach in the
outpatient clinic(4).
This finding, coupled with the fact that tumors
diagnosed in early stages have a better prognosis,
highlights the need for screening for cancer in
patients with idiopathic DVT. However, there are
studies that consider ultrasonography inefficient as
screening for tumors in patients with idiopathic
DVT and so do not recommend screening(1).
The true result of screening for cancer on the
prognosis of patients with idiopathic DVT and can-
cer remains unknown(6); although diagnosis is
reached early, there are no published studies report-
ing the survival of these patients.
It is well known that ultrasound is a method
that depends on the examiner. It is therefore possi-
ble that subtle changes go unnoticed in evaluations
made by less experienced professionals. However,
it is an innocuous examination, i.e. it does not harm
the patient, and when a change is suspected, the
patient can be screened using more accurate meth-
ods. Another important aspect is that this study
identifies other benign changes thereby adding
weight to indications.
Other criteria, such as age, may be useful in
the screening of patients at a higher risk for cancer
thereby increasing the likelihood of identifying
tumors by ultrasound. One study identified a preva-
lence of malignancies of from 16% to 26.8% in
patients with deep venous thrombosis between the
ages of 50 and 80 years, with a peak (26.8%) being
between 60 and 70 years old 1. The evaluation of
other causes of hypercoagulability is also important
to determine the etiology of the DVT(7-9).
Conclusion
Screening for paraneoplastic syndrome in
patients with idiopathic deep venous thrombosis is
recommended.
Figure1: illustrates the presence of thrombus
in the femoral vein.

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_______
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Use of ultrasonography to screen for occult cancer in patients with idiopathic venous thrombosis 453