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D‐Dimer test in cancer patients with suspected acute pulmonary embolism
Author(s) -
DI NISIO M.,
SOHNE M.,
KAMPHUISEN P. W.,
BÜLLER H. R.
Publication year - 2005
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2005.01323.x
Subject(s) - pulmonary embolism , d dimer , medicine , test (biology) , cancer , radiology , cardiology , paleontology , biology
Summary. Background: The safety of a D‐dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. Objectives: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. Methods: The diagnostic accuracy of DD (Tinaquant D‐dimer) was first retrospectively assessed in an unselected group of patients referred for suspected PE ( n = 350). Subsequently, the predictive value of the DD was validated in a group of consecutive inpatients and outpatients with clinically suspected PE prospectively enrolled in a management study ( n = 519). The results of the DD test in cancer patients were assessed according to the final diagnosis of PE and the 3‐month clinical follow‐up. Results: In the first study group, DD showed a sensitivity and a negative predictive value (NPV) of 100% and 100% in patients with cancer and 97% and 98% in those without malignancy, respectively. In the validation cohort, the sensitivity and NPV of DD were both 100% (95% CI 82%–100% and 72%–100%, respectively), whereas in patients without malignancy, the corresponding estimates were 93% (95% CI 87%–98%) and 97% (95% CI, 95%–99%), respectively. The specificity of DD was low in patients with (21%) and without cancer (53%). Conclusions: A negative DD result safely excludes the diagnosis of PE in patients with cancer. Because of the low specificity, when testing 100 patients with suspected PE, a normal DD concentration safely excludes PE in 15 patients with cancer and in 43 patients without cancer.