Role of computed tomography in detecting incidental venous thromboembolism in cancer patients

Abstract

Background: Cancer is one of the major risk factors for venous thromboembolism (VTE). The prevalence of incidental VTE among cancer patients in South Africa is unknown.
Aim: To determine the presence and location of VTE, find out if VTE is more common in certain cancer types, and to determine the role of human immunodeficiency virus (HIV) in the incidental finding of VTE among cancer patients.
Setting: This study was conducted at the Radiology Department at the Charlotte Maxeke Johannesburg Academic Hospital located in Johannesburg, South Africa.
Methods: There were 214 staging computed tomography (CT) scans of eligible adult cancer patients from January 2018 to June 2018. These were identified using a picture archiving and communication system (PACS) and analysed retrospectively by three consultant radiologists. Univariate analysis and multivariable logistic regression models were used to investigate associations between VTE and HIV, age, gender, ethnicity and common cancers.
Results: The mean age was 53 years (standard deviation [s.d.] 13.98) with the age range being 18–86 years, and 64% of these patients were female. Incidental VTE was 14.9% (95% confidence interval [CI] 10.7% – 20.4%). Pulmonary embolism (PE) accounted for 11.2%, while abdominal deep vein thrombosis (ADVT) accounted for 3.7%. Moreover, HIV-positive cancer patients were three times more likely to have VTE compared to HIV-negative cancer patients, with adjusted odds’ ratio 3.2 (1–10), p = 0.04. There was no association found between cancer type and VTE.
Conclusion: This study revealed cancer and HIV infection as risk factors for patients developing VTE. Pulmonary embolism was more common than ADVT. Actively search for VTE in cancer patients when reviewing staging CT scans.
Contribution: This is the first research in South Africa to determine the prevalence of incidental VTE among cancer patients.