Performance of

Venous thromboembolism (VTE) may be the first manifestation of cancer. We aimed at evaluating the performance of This was a pre-specified analysis of a systematic review and individual patient data meta-analysis including prospective studies assessing cancer screening in patients with unprovoked VTE. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FDG PET/CT were calculated based on cancer diagnosis during a 1-year follow-up period. Four studies were identified as using FDG PET/CT as part of their extensive screening strategy. Out of the 332 patients who underwent FDG PET/CT, the scan was interpreted as positive in 67 (20.2%), as equivocal in 27 (8.1%), and as negative in 238 (71.7%). Seventeen (5.1%) patients were diagnosed with cancer at inclusion or during the 12-month follow up period. All cancers were diagnosed at initial screening. Pooled sensitivity, specificity, NPV, and PPV were 87.3% (95% CI, 55.3 to 97.4), 70.2% (95% CI, 48.2 to 85.6), 98.9% (95% CI, 94.3 to 99.7), and 17.9% (95% CI, 8.5 to 33.6), respectively. FDG PET/CT appears to have satisfactory accuracy indices for cancer diagnosis in patients with unprovoked VTE. In particular, it exhibits a very high negative predictive value and could be used to rule out the presence of an underlying occult malignancy in this setting.

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Déclaration de conflit d'intérêts

Declaration of competing interest Dr. Le Gal holds an Early Researcher Award from the Province of Ontario; a Heart and Stroke Foundation of Canada (HSFC) Ontario Mid-Career Investigator Award; and the Chair on Diagnosis of Venous Thromboembolism from the Department of Medicine at the University of Ottawa. Dr. Salaun reports a grant from the French Health Ministry (PHRC Cancer 2008) during the conduct of the MVTEP study. Authors not named here have disclosed no conflicts of interest.