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Work-up of patients with malignancy after an intermediate-probability ventilation-perfusion scan: why don't
1Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Rationale And Objectives:
The authors determined whether there are specific patient characteristics associated with the clinical decision to eschew further diagnostic testing in patients in whom a ventilation-perfusion (V-P) scan indicates intermediate probability of pulmonary embolism (PE).
Materials And Methods:
The authors reviewed all intermediate-probability V-P scans obtained in a 12-month period. Patients were divided into two groups. Group 1 comprised patients in whom a definitive diagnosis of PE was not obtained and who were not treated for PE (n = 57); group 2 comprised patients in whom the diagnosis of PE was confirmed or excluded and who, if PE was confirmed, received appropriate treatment (n = 14). Age, gender, frequency of malignancy, and survival of patients in groups 1 and 2 were compared.
Results:
The frequency of malignancy was significantly greater in group 1 than in group 2 (P = .012). Although the estimated 2-year survival of group 1 patients was significantly less than that of group 2 patients (P = .039), this difference is likely due to confounding by age and malignancy.
Conclusion:
When an intermediate-probability V-P scan is obtained, physicians are significantly less likely to pursue a definitive diagnosis of PE in patients with malignancy.