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 who are not candidates for fast- track work- up in an organ- specific cancer pre- planned pathway (CPP). Denmark has a cancer pre- planned pathway for this population (NSSC- CPP), but several issues remain unclarified, for example, distribution and significance of symptoms and findings, and choice of imaging. Aim: To investigate symptoms, cancer diagnoses, and diagnostic yield of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDGPET/CT) in patients on NSSC- CPP to improve the overall diagnostic process. Design & settinfg: A retrospective medical chart review in a 1- year consecutive cohort (2020). Method: A total of 802 referrals were reviewed for diagnostic imaging in patients with NSSP from general practices, specialist practices, or the local hospital diagnostic centre responsible for NSSC Results: The study included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity of 85%, specificity of 87%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 96%. For 18FFDG- PET/CT, the numbers were sensitivity 82%, specificity 62%, PPV 33%, and NPV 94%. Patients frequently underwent subsequent examinations following initial imaging. Conclusion: The findings were in accordance with the literature. Patients with NSSC had a cancer obvious focus point for future studies to further optimise the NSSC- CPP work- up strategy.