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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-FDG-PET/CT) in patients on NSSC-CPP to improve the overall diagnostic process. Design & setting: 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-CPP. 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 18F-FDG-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 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 work-up strategy. [ABSTRACT FROM AUTHOR]

INTRODUCTION Use of an urgent fast-track pathway comprising contrast-enhanced computed tomography (CECT) is a recognised method for diagnostic evaluation of patients with non-specific symptoms. This study focused on a subgroup of patients with non-specific symptoms who are diagnosed outside of fast-track pathways. To investigate the cancer prevalence in patients with non-specific symptoms outside of fast-track pathways undergoing a thoracoabdominal CECT. METHODSThis was a retrospective observational study including patients referred for a thoracoabdominal CECT. Patients with non-specified symptoms were included. All pathology reports were reviewed to confirm histopathological findings. Data were collected during a one-year period from the Department of Radiology, Vejle Hospital. RESULTS A total of 238 patients were included; 125 (52.5%) women and 113 (47.5%) men. The median age was 69 years (range: 29-99 years). Fifty (21%) patients (25 men and 25 women) were diagnosed with malignant conditions by computed tomography (CT), all of which were confirmed by biopsy (median age = 68 years, range: 43-87 years). An additional ten patients had CT findings consistent with malignancies that were not confirmed by biopsy (median age = 86 years, range: 58-93 years). CONCLUSION We found a 21% prevalence of cancer. FUNDING none. TRIAL REGISTRATION not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)