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  • Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months

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General practice / Family practice
Original research
Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months
  1. Marie Møller1,
  2. Bue Juvik1,
  3. Stine Chabert Olesen1,
  4. Hanne Sandstrøm2,
  5. Erling Laxafoss3,
  6. Simon Bertram Reuter4,5,
  7. Uffe Bodtger1,4,5
  1. 1 Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
  2. 2 Radiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
  3. 3 Orthopedic Surgery, Copenhagen University Hospital, Kobenhavn, Denmark
  4. 4 Respiratory Medicine, Nastved Hospital, Nastved, Denmark
  5. 5 Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Bue Juvik; rbju{at}regionsjaelland.dk

Abstract

Objectives To describe the diagnostic properties of thoracoabdominal contrast-enhanced CT (ceCT), when general practitioners (GPs) managed referral to ceCT through the non-specific symptoms or signs of cancer-cancer patient pathway (NSSC-CPP).

Design Retrospective cohort study including patients from a part of Denmark.

Setting Department of Internal Medicine at a university hospital.

Participants In total, 529 patients underwent ceCT.

Primary and secondary outcomes Our primary objective was to estimate the negative and positive likelihood ratios for being diagnosed with cancer within 1 year after ceCT. Our secondary outcomes were prevalence and final diagnoses of malignancy (including temporal trends since implementation of NSSC-CPP in 2012), the prevalence of revision of CT scans and referral patterns based on ceCT results.

Results In total, 529 subjects underwent ceCT and malignancy was identified in 104 (19.7%) patients; 101 (97.1%) during initial workup and 3 patients during the subsequent 12 months follow-up.

Eleven patients had a false-negative ceCT, and revision classified the ceCT as ‘probable/possible malignancy’ in eight (73%) patients. The negative predictive value was 98% and positive predictive value 63%. Negative and positive likelihood ratios for malignancy was 0.1 and 7.9, respectively.

Conclusion Our study shows that ceCT as part of GP-coordinated workup has a low negative likelihood ratio for identifying malignancy; this is important since identifying patients for further workup is vital.

  • computed tomography
  • cancer
  • diagnostic radiology
  • general practice
  • Denmark
  • cancer patient pathway

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032019

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    Footnotes

    • Contributors MM, BJ, SCO, HS, EL, SBR and UB helped in the conception and design of the study. BJ and UB performed administrative support. MM, BJ and UB helped in supplying the provision of study materials or patients. MM helped in the collection and assembly of data. MM, BJ, SCO, HS, EL, SBR and UB performed the data analysis and interpretation and helped in manuscript writing. All authors approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approval from the Danish Patient Safety Authority and the Danish Data Protection Agency were obtained before any study-related activity.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.