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Supportive Care in Cancer

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Open Access 01-03-2021 | Prostate Cancer | Original Article

Incidental pulmonary embolism in oncologic patients—a systematic review and meta-analysis

Authors: Hans-Jonas Meyer, Andreas Wienke, Alexey Surov

Published in: Supportive Care in Cancer | Issue 3/2021

Abstract

Purpose

Incidental pulmonary embolism (IPE) is a common finding on computed tomography (CT). IPE is frequent in oncologic patients undergoing staging CT. The aim of this analysis was to provide the pooled frequency of IPE and frequencies of IPE in different primary tumors.

Methods

MEDLINE, SCOPUS, and EMBASE databases were screened for studies investigating frequency of IPE in oncologic staging CT up to February 2020. Overall, 12 studies met the inclusion criteria and were included into the present study.

Results

The pooled analysis yielded a total of 28,626 patients. IPE was identified in 963 patients (3.36%, 95% CI = 3.15; 3.57). The highest frequency was found in prostate cancer (8.59%, 95%CI = 3.74; 13.44), followed by hepatobiliary carcinoma (6.07%, 95%CI = 3.09; 9.05) and pancreatic cancer (5.65%, 95%CI = 3.54; 7.76). The lowest frequencies were identified in tumors of male reproductive organs (0.79%, 95%CI = 0.21; 1.37) and hematological diseases (1.11% 95%CI = 0.74; 1.48).

Conclusion

The overall frequency of IPE in oncologic patients was 3.36%. There are considerable differences in regard to primary tumors with the highest frequency in prostate cancer and pancreatic and hepatobiliary carcinomas.

Klok FA, Huisman MV (2017) Management of incidental pulmonary embolism. Eur Respir J 49:1700275CrossRef

Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Tagawa ST, Panageas KS, DeAngelis LM (2019) Arterial thromboembolic events preceding the diagnosis of cancer in older persons. Blood 133:781–789CrossRef

Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Bounameaux H, Büller HR (2013) International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 11:56–70CrossRef

Albrecht MH, Bickford MW, Nance JW Jr, Zhang L, De Cecco CN, Wichmann JL, Vogl TJ, Schoepf UJ (2017) State-of-the-art pulmonary CT angiography for acute pulmonary embolism. AJR Am J Roentgenol 208:495–504CrossRef

den Exter PL, van der Hulle T, Hartmann IJ, Jiménez D, Klok FA, Huisman MV, Kroft LJ (2015) Reliability of diagnosing incidental pulmonary embolism in cancer patients. Thromb Res 136:531–534CrossRef

Wiener RS, Schwartz LM, Woloshin S (2013) When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 347:f3368CrossRef

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef

Aleem A, Al Diab AR, Alsaleh K, Algahtani F, Alsaeed E, Iqbal Z, El-Sherkawy MS (2012) Frequency, clinical pattern and outcome of thrombosis in cancer patients in Saudi Arabia. Asian Pac J Cancer Prev 13:1311–1315CrossRef

Bach AG, Schmoll HJ, Beckel C, Behrmann C, Spielmann RP, Wienke A, Abbas J, Surov A (2014) Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol 55:45–53CrossRef

10.

Browne AM, Cronin CG, English C, NiMhuircheartaigh J, Murphy JM, Bruzzi JF (2010) Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging. J Thorac Oncol 5:798–803CrossRef

11.

Cronin CG, Lohan DG, Keane M, Roche C, Murphy JM (2007) Prevalence and significance of asymptomatic venous thromboembolic disease found on oncologic staging CT. AJR Am J Roentgenol 189:162–170CrossRef

12.

Deniz MA, Deniz ZT, Adin ME, Akıl F, Turmak M, Urakcı Z, Cetincakmak MG, Goya C (2017) Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients. Clin Imaging 41:106–111CrossRef

13.

Douma RA, Kok MG, Verberne LM, Kamphuisen PW, Büller HR (2010) Incidental venous thromboembolism in cancer patients: prevalence and consequence. Thromb Res 125:e306–e309CrossRef

14.

Engelke C, Manstein P, Rummeny EJ, Marten K (2006) Suspected and incidental pulmonary embolism on multidetector-row CT: analysis of technical and morphological factors influencing the diagnosis in a cross-sectional cancer Centre patient cohort. Clin Radiol 61:71–80CrossRef

15.

Gladish GW, Choe DH, Marom EM, Sabloff BS, Broemeling LD, Munden RF (2006) Incidental pulmonary emboli in oncology patients: prevalence, CT evaluation, and natural history. Radiology 240:246–255CrossRef

16.

Myat Moe MM, Redla S (2018) Incidental pulmonary embolism in oncology patients with current macroscopic malignancy: incidence in different tumour type and impact of delayed treatment on survival outcome. Br J Radiol 91:20170806CrossRef

17.

Shinagare AB, Guo M, Hatabu H, Krajewski KM, Andriole K, Van den Abbeele AD, DiPiro PJ, Nishino M (2011) Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer 117:3860–3866CrossRef

18.

Di Nisio M, Ferrante N, De Tursi M, Iacobelli S, Cuccurullo F, Büller HR, Feragalli B, Porreca E (2010) Incidental venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Thromb Haemost 104:1049–1054CrossRef

19.

Kilburn A, Iddles SI, Carrington BM (2018) Radiographer screening for incidental pulmonary emboli on routine contrast-enhanced computerised tomography scans at a cancer centre. Clin Radiol 73:219.e1–219.e7CrossRef

20.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MG, Sterne JA, Bossuyt PM (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRef

21.

Deeks JJ, Higgins JPT, Altman DG (2008) Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions. Wiley, Chichester

22.

Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (2000) Methods for meta-analysis in medical research. Wiley, New York

23.

Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897CrossRef

24.

Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31CrossRef

25.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRef

26.

Ohashi Y, Ikeda M, Kunitoh H, Sasako M, Okusaka T, Mukai H, Fujiwara K, Nakamura M, Kimura T, Ibusuki K, Sakon M (2018) Venous thromboembolism in patients with cancer: design and rationale of a multicentre, prospective registry (Cancer-VTE registry). BMJ Open 8:e018910PubMedPubMedCentral

27.

Sharathkumar AA, Biss T, Kulkarni K, Ahuja S, Regan M, Male C, Reve-Wilk S (2020) Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: a systematic review. J Thromb Haemost 18:1100–1112CrossRef

28.

Cohen AT, Katholing A, Rietbrock S, Bamber L, Martinez C (2017) Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost 117:57–65CrossRef

29.

Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N, Imberti D, Squizzato A, Venco A, Agnelli G (2010) Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res 125:518–522CrossRef

30.

Thaker DA, Douglas E, Blazak J, Xu W, Hughes B, Burge M, Steinke K, Wyld D (2017) An analysis of incidental and symptomatic pulmonary embolism (PE) in medical oncology patients. Asia Pac J Clin Oncol 13:243–248CrossRef

31.

Bach AG, Meyer HJ, Taute BM, Surov A (2016) The frequency of incidental pulmonary embolism in different CT examinations. Br J Radiol 89:20150737CrossRef

32.

den Exter PL, Kroft LJ, van der Hulle T, Klok FA, Jiménez D, Huisman MV (2013) Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients. J Thromb Haemost 11:1620–1622CrossRef

33.

Bleker SM, Beenen LF, Di Nisio M, van Es N, Büller HR, Kraaijpoel N, Rutten A (2016) Incidental pulmonary embolism in cancer patients: Interobserver agreement on the diagnosis and extent with a focus on distal clots. Thromb Res 147:46–51CrossRef

34.

Uhrig M, Simons D, Schlemmer HP (2018) Incidental pulmonary emboli in stage IV melanoma patients: prevalence in CT staging examinations and improved detection with vessel reconstructions based on dual energy CT. PLoS One 13:e0199458CrossRef

35.

Van Hemelrijck M, Adolfsson J, Garmo H, Bill-Axelson A, Bratt O, Ingelsson E, Lambe M, Stattin P, Holmberg L (2010) Risk of thromboembolic diseases in men with prostate cancer: results from the population-based PCBaSe Sweden. Lancet Oncol 11:450–458CrossRef

36.

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007) Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 110:2339–2346CrossRef

37.

Ansari D, Ansari D, Andersson R, Andrén-Sandberg Å (2015) Pancreatic cancer and thromboembolic disease, 150 years after trousseau. Hepatobiliary Surg Nutr 4:325–335PubMedPubMedCentral

38.

Majmudar K, Quintero LD, Fuentes HE, Stocker S, Tafur AJ, Lee CJ, Talamonti M (2019) Postoperative venous thromboembolism and mortality in patients with pancreatic surgery. J Surg Oncol 120:494–500CrossRef

39.

Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Khorana AA (2008) Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 122:299–306CrossRef

40.

Adra N, Einhorn LH (2017) Testicular cancer update. Clin Adv Hematol Oncol 15:386–396PubMed

41.

Gizzi M, Oberic L, Massard C, Poterie A, Le Teuff G, Loriot Y, Albiges L, Baciarello G, Michels J, Bossi A, Blanchard P, Escudier B, Fizazi K (2016) Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours. Eur J Cancer 69:151–157CrossRef

Title: Incidental pulmonary embolism in oncologic patients—a systematic review and meta-analysis
Authors: Hans-Jonas Meyer
Andreas Wienke
Alexey Surov
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Computed Tomography
Computed Tomography
Prostate Cancer
Pancreatic Cancer
Pancreatic Cancer
Published in: Supportive Care in Cancer / Issue 3/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05601-y

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