Patients from general practice with non-specific cancer symptoms: a retrospective study of symptoms and imaging

Background Patients with non-specific symptoms or signs of cancer (NSSC) present a challenge as they are a heterogeneous population that are not candidates for fast-track work-up in an organ-specific cancer preplanned pathway. Denmark has a cancer preplanned pathway for this population (NSSC-CPP), but several issues remain unclarified, eg, distribution and significance of symptoms and findings and choice of imaging.

Aim We investigated symptoms, cancer diagnoses, and diagnostic yield of CT and [¹⁸F]FDG-PET/CT in NSSC-CPP patients to improve the overall diagnostic process.

Design & setting A retrospective medical chart review in a one-year consecutive cohort (2020).

Method We reviewed 802 referrals for diagnostic imaging in patients with NSSP from general practices, specialist practices or the local hospital diagnostic centre responsible for NSSC-CPP.

Results We included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 85%, 87%, 65% and 96%, respectively. For [¹⁸F]FDG-PET/CT, the numbers were 82%, 62%, 33% and 94%. Patients frequently underwent subsequent examinations following initial imaging.

Conclusions Our findings were in accordance with the literature. Patients with non-specific symptoms or signs of cancer had a cancer prevalence of 21%, most frequently gastrointestinal. The most frequent symptom was weight loss and even as the only symptom, it is a potential marker for cancer. CT and [¹⁸F]FDG-PET/CT were sensitive with high NPV, whereas PPV was superior in CT. Better stratification by symptoms or findings is an obvious focus point for future studies to further optimise the NSSC-CPP workup strategy.