Background: Venous thromboembolism (VTE) and superficial thrombophlebitis (STP) have long been associated with cancer. Investigation of patients with VTE or STP may allow early diagnosis of an occult malignancy, however the benefit of extensive screening remains controversial. The Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) score aims to identify patients at higher risk of occult malignancy. It is calculated using only patient information and a full blood count.

Aims: To evaluate the efficacy of the RIETE score at identifying occult malignancy in patents diagnosed with VTE or STP.

Methods: We analyzed all patients managed through our outpatient VTE service in 2019. At present patients are reviewed in clinic, along with a panel of bloods including tumor markers and a myeloma screen. The RIETE score was retrospectively applied and we followed patients for a minimum of one year to determine if they were subsequently diagnosed with a malignancy.

Results: After exclusions, 390 patients were included in the study, of which 28 (7%) were identified as having a malignancy during this time.
The RIETE score was applied using a cut off score of 3 or greater. This returned a sensitivity for cancer of 0.54 (95% confidence interval 0.34 – 0.72), a positive predictive value of 0.17 (0.12 – 0.27) and a negative predictive value was 0.96 (0.93 – 0.98). Looking specifically at patients with PE the positive predictive value was 0.23 (0.05 – 0.54), with DVT 0.18 (0.09 – 0.31) and with STP 0.11 (0.02 – 0.29).

Bar chart to show the distribution of patients by RIETE score and the outcome of cancer screeningFigure 1

Bar chart to show the proportion of patients at each RIETE score who went on to be diagnosed with malignancy.Figure 2

Conclusions: This retrospective analysis demonstrates acceptable positive and negative predictive values for patients with PE, DVT and STP. Wider use could assist the diagnosis of occult malignancy in these patients, as well as reducing unnecessary investigation and consequent patient anxiety. Following this study, we will use the RIETE score to discriminate which patients undergo further investigation.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-riete-score-a-useful-screening-tool-for-occult-malignancy-in-vte-and-stp/