CT referrals and cancer detection in patients referred by general practitioners with non-specific symptoms and signs of cancer: A retrospective study
Noa Larsen Ohana, Josefine Axelsen, Maja Sundahl Wilkinson, Ole Graumann, Kim Sivesgaard, Thomas Winther Buus, Peter Vedsted, Anette Midtgaard, Stine Bisgaard Greve, Solveig Kärk Abildtrup LarsenBackground
In Denmark, since 2011-2012, a national cancer patient pathway (CPP) has been in place for patients presenting with non-specific signs or symptoms of and signs of cancer (NSSC). Many cancer patients initially do not display organ-specific alarm symptoms when examined by general practitioners (GPs).
Purpose
To characterize referral symptoms in patients undergoing contrast-enhanced CT chest-abdomen-pelvis (TAP) for non-specific signs of cancer or vague symptoms, in relation to radiological findings and final diagnoses. Second, the study assessed diagnostic accuracy of CT TAP for detecting malignancy in these patient groups.
Materials and Methods
This retrospective cohort study included all patients referred by GPs to CT TAP at Aarhus University Hospital, Denmark through NSSC or vague cancer symptoms from May to August 2024. Referral symptoms and radiology reports were compared to final clinical diagnosis at the end of NSSC-CPP.
Results
The study included 725 patients. The most frequent referral symptoms were weight loss (51.3%), pain (45.0%), and fatigue (39.4%). CT TAP reports indicated that 20.6% of cases had findings suggestive of cancer, most commonly lung cancer. Overall, 9.2% received a malignant diagnosis, most commonly lymphoma or lung, pancreatic, and colorectal cancer, while 11.3% received a benign diagnosis. Cancer was rare in patients with vague symptoms.
Conclusion
This study demonstrates that CT TAP is a valuable tool for diagnosing patients with non-specific signs or symptoms of cancer in general practice. These findings support the continued use of CT TAP within the cancer pathway as an important tool for identifying patients who need further investigation.