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Incidental pulmonary embolism in cancer patients: Interobserver agreement on the diagnosis and extent with a focus on distal clots.

Published on Nov 1, 2016in Thrombosis Research3.266
· DOI :10.1016/j.thromres.2016.09.015
S.M. Bleker4
Estimated H-index: 4
,
L.F.M. Beenen1
Estimated H-index: 1
+ 4 AuthorsA. Rutten1
Estimated H-index: 1
Abstract
Abstract Background The incidence of incidental pulmonary embolism (IPE) in cancer patients is increasing. There is scant information on the interobserver agreement among radiologists about the diagnosis of distal incidental clots and the actual radiologic extension of IPE. Methods A total of 88 contrast-enhanced computed tomography (CT) scans of cancer patients with IPE were reassessed blindly by two expert thoracic radiologists. First, 62 scans were reassessed and the interobserver agreement on most proximal extent of IPE was calculated between the two expert radiologists as well as between the initial and expert reading, using the kappa statistic. The sample was enriched with 26 additional scans for a total of 30 segmental and 29 subsegmental IPE to determine the interobserver agreement on distal clots. Results The level of agreement regarding the most proximal extent of IPE between the expert radiologists was very good (kappa 0.84; 95% CI, 0.73–0.95) and poor between the original radiologist and expert radiologists (kappa 0.39; 95% CI, 0.22–0.56). In the patients with segmental or subsegmental IPE on initial reading, the expert radiologists agreed with the segmental location in 12 out of 30 patients (40%) and with the subsegmental location in 17 out of 29 patients (59%). The interobserver agreement between the expert radiologists was good (kappa 0.68; 95% CI, 0.46–0.90) and moderate (kappa 0.48; 95% CI, 0.25–0.71), respectively. Conclusions While the interobserver agreement between radiologists on the most proximal location of IPE in cancer patients appears to be fairly good, it decreases significantly for more distally located incidental clots.
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References31
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#1David Spirk (University of Bern)H-Index: 6
#2Drahomir Aujesky (University of Bern)H-Index: 44
Last. Nils Kucher (University of Bern)H-Index: 38
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Background The association between cancer and venous thromboembolism (VTE) in producing adverse clinical outcomes requires further investigation. Methods In the Swiss Venous ThromboEmbolism Registry (SWIVTER), we compared adverse clinical outcomes between 493 patients with cancer-associated VTE and 1,569 VTE patients without cancer, and identified independent predictors of 90-day mortality. Results Among cancer patients, 351 (71%) had active disease at the time of VTE diagnosis and 232 (47%) had...
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#1T. van der Hulle (LUMC: Leiden University Medical Center)H-Index: 10
#2P. L. den Exter (LUMC: Leiden University Medical Center)H-Index: 13
Last. Fredrikus A. Klok (LUMC: Leiden University Medical Center)H-Index: 34
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Essentials We performed a pooled analysis of 926 patients with cancer-associated incidental pulmonary embolism (IPE). Vitamin K antagonists (VKA) are associated with a higher risk of major hemorrhage. Recurrence risk is comparable after subsegmental and more proximally localized IPE. Our results support low molecular weight heparins over VKA and similar management of subsegmental IPE. SummaryBackground Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on compute...
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Introduction: Patients with cancer are at increased risk of (recurrent) venous thromboembolism. They are also at increased risk of bleeding. This makes treatment of venous thromboembolisms (VTE) in cancer patients challenging.Areas covered: In this review, we will focus on the safety of anticoagulant treatment of VTE in cancer patients. We will discuss the absolute and relative bleeding risks associated with the various types of anticoagulants, specifically focusing on low-molecular-weight hepar...
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Modern computer tomography (CT) with its higher sensitivity and resolution has increased the detection of incidental venous thromboembolism (VTE) in the venous and pulmonary vasculature during routine imaging for cancer staging and response assessment [1]. As a result, up to half of all VTEs diagnosed in oncology centers are incidental [1-5]. Although widely accepted, the diagnosis of incidental VTE is made without using the standard imaging studies required for confirming the presence of sympto...
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The clinical significance of subsegmental pulmonary embolism (SSPE) remains to be determined. This study aimed to investigate whether SSPE forms a distinct subset of thromboembolic disease compared with more proximally located pulmonary embolism (PE). We analyzed 3728 consecutive patients with
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Purpose Compare the clinical characteristics, rate of recurrent venous thromboembolism (VTE) and outcome of suspected and unsuspected pulmonary embolism (PE) detected on computed tomography in patients with lung cancer.
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Purpose The routine use of modern computed tomography scanners has led to an increased detection of incidental pulmonary embolism (PE), in particular in patients with cancer. The clinical relevance of these incidental findings is unknown. Patients and Methods In this retrospective cohort study, oncology patients in whom PE was objectively proven between 2004 and 2010 and anticoagulant treatment was started, were included. Fifty-one patients with incidental PE and 144 with symptomatic PE were obs...
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