WORK-UP OF PATIENTS WITH MALIGNANCY AFTER AN INTERMEDIATE-PROBABILITYVENTILATION-PERFUSION SCAN - WHY DONT PHYSICIANS PURSUE A DEFINITIVE DIAGNOSIS

Rational and Objectives. The authors determined whether there are spec ific patient characteristics associated with the clinical decision to eschew further diagnostic testing in patients in whom a ventilation-pe rfusion (V-P) scan indicates intermediate probability of pulmonary emb olism (PE). Materials and Methods. The authors reviewed all intermedia te-probability V-P scans obtained in a 12-month period. Patients were divided into two groups. Group 1 comprised patients in whom a definiti ve 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 con firmed 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 o f 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 dif ference is likely due to confounding by age and malignancy. Conclusion . When an intermediate-probability V-P scan is obtained, physicians ar e significantly less likely to pursue a definitive diagnosis of PE in patients with malignancy.