Advanced Diagnostic Imaging Research Articles

How is stereotactic brain biopsy evolving? A multicentric analysis of a series of 421 cases treated in Rome over the last sixteen years

ObjectiveIn recent decades, frame-based (FBB) and frame-less stereotactic brain biopsy (FLB) have played a crucial role in defining the diagnosis and management of expanding intracranial lesions in critical areas. During the same period, there have been significant advances in diagnostic imaging, a shift in surgical strategies towards extensive resection in gliomas and new molecular classification of brain tumors. Taking these advances into account, we have evaluated whether significant changes have occurred over the last sixteen years of our clinical practice in terms of frequency, indications, target selection, and the histologic results of stereotactic brain biopsy (SBB) procedures. Patients and MethodsWe analyzed a series of 421 SBB cases treated between January 2002 and June 2017 in three major neurosurgical institutes in Rome, serving a total of 1.5 million people. Within this series, 94.8% of patients underwent FBB, while, more recently, FLB was performed in 5.2% of cases. The entire period under consideration, running from 2002 to 2017, has been further stratified into four-year time-frames (2002–2005, 2006–2009, 2010–2013, 2014–2017) for the purpose of analysis. ResultsThe diagnostic yield was 97%. Final diagnoses revealed tumors in 90% of cases and non-neoplastic masses in 7%, while 3% of cases were not conclusive.The morbidity rate was 3% (12 cases) and mortality was 0.7% (3 cases). Intra-operative frozen sections were made in 78% of biopsies.In our three institutes, the number of SBBs decreased steadily throughout the time-frames under consideration. We have also observed a statistically significant reduction in biopsy procedures in lobar lesions, while those performed on the basal ganglia increased and the number of SBBs of multiple masses and lesions of the corpus callosum remained stable. Primary central nervous system diagnosis of lymphomas (PCNSL) was the sole diagnosis whose incidence increased significantly. ConclusionsOver the last sixteen years, we have witnessed a significant decrease in SBB procedures and a modification in target selection and histologic results. Despite the significant evolution of neuroimaging, an accurate non-invasive diagnosis of intracranial expanding lesions has not yet been achieved. Furthermore, the most recent WHO classification of brain tumors (2016), which incorporates molecular and morphological features, has boosted the need for molecular processing of tissue samples in all expanding brain lesions. For these reasons, it is likely that SBBs will continue to be performed in specific cases, playing a significant role in diagnostic confirmation by providing tissue samples, so as to better assess the biology and the prognosis of cerebral lesions, as well as their sensitivity to standard radio-chemotherapy or to new molecular target therapies.

The Importance of Subchondral Bone in the Pathophysiology of Osteoarthritis.

Subchondral bone plays a critical role in the pathogenesis of osteochondral disease across veterinary species. The subchondral bone is highly adaptable, with the ability to model and remodel in response to loading stresses experienced by the joint. Repetitive stress injuries within the joint can result in primary or secondary pathologic lesions within the subchondral bone, which have been recognized to contribute to the development and progression of osteoarthritis. Recent advances in diagnostic imaging, particularly volumetric imaging modalities have facilitated earlier identification of subchondral bone disease. Despite these advancements, limitations in our knowledge about subchondral bone makes treatment and prevention of these conditions challenging. The purpose of this report is to review our current understanding of subchondral bone and its relationship to osteoarthritis across veterinary species, with a specific focus in the research that has been performed in horses. It can be concluded that our current understanding of subchondral bone is advancing, and future experimental, clinical and pathologic studies will provide additional insight about subchondral bone and its relationship to joint disease.

Designing Customized 3D Printed Models for Surgical Planning in Repair of Congenital Heart Defects

Advances in diagnostic imaging and 3D printing technologyhave enabled the creation of patient-specic models. Thisresearch established a wor kow for creating 3D printedcongenital hear t defec t (CHD) models, focusing specically oncreating aor tic arch models optimized for surgical planning andsimulation for hypoplastic left hear t syndrome (HLHS) stage Ipalliation. Novel methods for creating C T as well as 3Dultrasound and 3D fetal ultrasound derived prints were explored.

Stenting in type A aortic dissection: fantasy or reality?

Open surgical repair of the ascending aorta in ATAAD is the gold standard method of management (1). With improvement in perioperative management and earlier surgical intervention secondary to advances in diagnostic imaging, the mortality rate has dramatically reduced.

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 24. Cervical angiograms in cervical spine trauma patients five years after the data: has practice changed?

BACKGROUND CONTEXT Advanced diagnostic imaging utilizing CT technology has made angiography easier and faster to obtain in the trauma setting. Prior studies have shown that the rates of symptomatic vertebral artery injuries (VAI) are relatively low in the trauma population, approximately 0.1%, but that screening a broader population of asymptomatic trauma patients can increase the rate of injuries diagnosed to near 1%2. While CT angiography (CTA) can readily provide a diagnosis, clinical significance of a positive result in polytrauma patients is limited by the high number of concomitant injuries and limit the number of patients who are candidates for therapeutic anticoagulation or other treatments. PURPOSE At our institution, this had been described in a previous five-year study and the information disseminated between trauma attending physicians and the orthopedic department. We sought to retrospectively evaluate the patterns use of CTA in the trauma population at the authors’ institution for the five years after this intervention was taken to evaluate for changes in practice. STUDY DESIGN/SETTING Retrospective observational study at a Level 1 trauma hospital. PATIENT SAMPLE A total of 1,201 charts from 2011 to 2016 were reviewed including all level 1 and 2 trauma patients with cervical spine complaints and 1,142 subjects were eligible for inclusion. This time frame begins after the prior referenced study by Dreger et al was completed and results of the study had been disseminated among the trauma and orthopedic faculty OUTCOME MEASURES Outcome measures were positive CTA study, and treatment for diagnosed vertebral artery injury. METHODS A total of 1,201 charts were reviewed. A total of 1,142 subjects were eligible for inclusion, and 187 subjects underwent CTA/MRA. A total of 640 patients had cervical spine fractures, and of these 158 patients had CTA/MRA. Inclusion criteria were ages 18-89, and imaging of the cervical spine performed. Exclusion criteria were ballistic or penetrating trauma to the neck, death on arrival to the emergency department without imaging performed, and imaging performed at outside institution only. Statistical analysis was performed using SPSS. RESULTS Twenty-four patients were diagnosed with VAI, and 12 were treated for these findings. None of the subjects treated had complications from angiography, one patient with VAI had increased blood loss after initiation of therapeutic anticoagulation requiring transfusion. There has been a significant increase in CTA/MRA testing done at our institution (P CONCLUSIONS Despite discussion at our institution of the clinical utility of CTA in the trauma population, there are more CTA studies being done and the number of patient's diagnosed and treated for VAI have not changed. The presence of symptoms and risk of bleeding or other complications of therapeutic anticoagulation in this population are important factors to consider when ordering this test. We recommend the use of a treatment algorithm in the electronic ordering system to help aid practitioners in targeting the use of this test. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The crack detection and evaluation by elastic wave propagation in open hole structures for aerospace application

The rectangular plate made of aluminum alloy with a relatively large circular hole in the geometrical center of the structure is subjected to uniform tension. This loading causes that in the vicinity of a hole a process of crack formation is triggered. The crack is detected and evaluated with the use of elastic wave propagation method. The piezoelectric activator is located directly on the edge of the hole and the rest of sensors are placed at an equal distance from the activator. The crack is detected by comparison of the reference, obtained for the intact plate, and the actual signal (pitch-catch measurement). The appropriate damage magnitude measurement is proposed. Moreover, the system, which works without knowledge of an intact structure, is also discussed. In order to estimate and visualize the length of a crack, the advanced diagnostic imaging is introduced. The applied method is based on a visualization of sensing paths with an assigned value of correlation coefficients, computed for reference and actual signals. The effectiveness of the described system is verified with the use of numerical simulation and experimental test. The theoretical analysis is carried out with the use of the finite element method. The computations are performed for several assumed lengths of cracks. The obtained theoretical results, as well as the experimental analysis, confirm the fact that the crack can be detected at an early stage of formation. Moreover, a relatively good agreement between the real crack lengths and the ones obtained with the use of the proposed method is observed in the numerical analysis as well as in the experiment.

Digital Design and 3D Printing of Aortic Arch Reconstruction in HLHS for Surgical Simulation and Training.

Patients with hypoplastic left heart syndrome (HLHS) present a diverse spectrum of aortic arch morphology. Suboptimal geometry of the reconstructed aortic arch may result from inappropriate size and shape of an implanted patch and may be associated with poor outcomes. Meanwhile, advances in diagnostic imaging, computer-aided design, and three-dimensional (3D) printing technology have enabled the creation of 3D models. The purpose of this study is to create a surgical simulation and training model for aortic arch reconstruction. Specialized segmentation software was used to isolate aortic arch anatomy from HLHS computed tomography scan images to create digital 3D models. Three-dimensional modeling software was used to modify the exported segmented models and digitally design printable customized patches that were optimally sized for arch reconstruction. Life-sized models of HLHS aortic arch anatomy and a digitally derived customized patch were 3D printed to allow simulation of surgical suturing and reconstruction. The patient-specific customized patch was successfully used for surgical simulation. Feasibility of digital design and 3D printing of patient-specific patches for aortic arch reconstruction has been demonstrated. The technology facilitates surgical simulation. Surgical training that leads to an understanding of optimal aortic patch geometry is one element that may potentially influence outcomes for patients with HLHS.

Is the Scotty Dog Sign Adequate for Diagnosis of Fractures in Pediatric Patients with Lumbar Spondylolysis?

Introduction Recent advances in diagnostic imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), have allowed early diagnosis of lumbar spondylolysis (LS). However, few outpatient clinics are equipped with such imaging apparatuses and must rely on plain radiographs for the diagnosis of LS. The aim of this retrospective study was to identify how accurately fracture lines can be detected on plain radiographs in patients with LS. MethodsPatients with a diagnosis of LS were staged as early, progressive, or terminal. We evaluated whether fracture lines could be detected on plain radiographs and compared the detection rates under the following conditions: two directions including anteroposterior and lateral views (2 views), four directions including both oblique views (4 views), four directions including dynamic lateral views (4-D views), and all six directions (6 views). Results In early LS, the fracture line detection rate was 11.4% using 2 views, 20.5% using 4 views and 4-D views, and 22.7% using 6 views. In progressive LS, the fracture line detection rate was 54.2% using 2 views, 70.8% using 4-D views, 75.0% using 4 views, and 79.2% using 6 views. The respective detection rates for terminal LS were 85.0%, 100%, 100%, and 100%. Conclusions Although terminal LS was diagnosed accurately on plain radiographs in all patients, the detection rates were only 22.7% and 79.2% in patients with early and progressive LS, respectively. These results suggest that plain radiographic films can no longer be considered adequate for early and accurate diagnosis of LS. Advanced imaging procedures, such as MRI in the early diagnosis or CT for persistent cases, are recommended to obtain an accurate diagnosis of early stage LS in pediatric patients requiring conservative treatment to achieve bony healing.

Prototype design of singles processing unit for the small animal PET

Position Emission Tomography (PET) is an advanced clinical diagnostic imaging technique for nuclear medicine. Small animal PET is increasingly used for studying the animal model of disease, new drugs and new therapies. A prototype of Singles Processing Unit (SPU) for a small animal PET system was designed to obtain the time, energy, and position information. The energy and position is actually calculated through high precison charge measurement, which is based on amplification, shaping, A/D conversion and area calculation in digital signal processing domian. Analysis and simulations were also conducted to optimize the key parameters in system design. Initial tests indicate that the charge and time precision is better than 3‰ FWHM and 350 ps FWHM respectively, while the position resolution is better than 3.5‰ FWHM. Commination tests of the SPU prototype with the PET detector indicate that the system time precision is better than 2.5 ns, while the flood map and energy spectra concored well with the expected.

Lameness originating from the proximal metacarpus/tarsus: A review of local analgesic techniques and clinical diagnostic findings

SummaryAccurate diagnosis of conditions of the equine proximal metacarpus and metatarsus presents a clinical challenge. Diagnostic analgesia of this region is nonspecific, which may lead to incorrect interpretation of blocking patterns, potentiating incorrect diagnoses and treatment. Results of local analgesia should be examined carefully during clinical lameness evaluations due to the possibility of diffusion of local anaesthetic solution and inadvertent intrasynovial injection. Supplementary diagnostic analgesia of surrounding anatomic regions and advanced diagnostic imaging, particularly magnetic resonance imaging, are recommended for most accurate diagnosis of lameness. Failure in response to therapy in cases where supplementary diagnostic analgesia and advanced diagnostic imaging have not been performed should prompt the clinician to broaden the approach to better characterise the site of pain.

Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors

PurposeThe aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors. MethodsAn institutional review board–approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data and demographic information were obtained. Imaging missed appointments were defined as missed scheduled imaging encounters. WDs were defined as the number of days from study order to appointment. Multivariate logistic regression was applied to assess the contribution of race and socioeconomic factors to missed appointments. Linear regression was performed to assess the relationship between missed appointment rates and WDs stratified by race, income, and patient insurance groups with analysis of covariance statistics. ResultsA total of 42,727 patients met the inclusion criteria. Mean WDs were 7.95 days. Multivariate regression showed increased odds ratio for missed appointments for patients with increased WDs (7-21 days: odds ratio [OR], 1.39; >21 days: OR, 1.77), African American patients (OR, 1.71), Hispanic patients (OR, 1.30), patients with noncommercial insurance (OR, 2.00-2.55), and those with imaging performed at the main hospital campus (OR, 1.51). Missed appointment rate linearly increased with WDs, with analysis of covariance revealing underrepresented minorities and Medicaid insurance as significant effect modifiers. ConclusionsIncreased WDs for advanced imaging significantly increases the likelihood of missed appointments. This effect is most pronounced among underrepresented minorities and patients with lower socioeconomic status. Efforts to reduce WDs may improve equity in access to and utilization of advanced diagnostic imaging for all patients.

Revenue Increase following 2017 Multiple Procedures Payment Reduction Modification: Differential Impact on Neuroradiology-Report from an Academic Medical Center.

The Centers for Medicare and Medicaid Services imposed a 25% professional component multiple procedure payment reduction for the professional component of advanced diagnostic imaging modalities in January 2012. In 2017, the Centers for Medicare and Medicaid Services rolled back the multiple procedure payment reduction to 5% for subsequent imaging. To evaluate the effect of this change, we analyzed 5 months of Centers for Medicare and Medicaid Services procedures at Johns Hopkins Medical Institution. We analyzed the procedure codes and reimbursement rate for studies performed between January 1 and May 31, 2017. Patients with Medicare insurance who had multiple diagnostic procedures in a day were selected. Per the Centers for Medicare and Medicaid Services guidelines, procedures with the highest price were considered fully reimbursed and subsequent studies were marked for differences between 25% (2013-2016) and 5% reduction (2017). We included 8787 patients with 22,236 procedures (mean, 2.53 studies/day). CT, MR imaging, and ultrasound scans composed 75.9%, 21.5%, and 2.6% of all studies, with 61.2%, 54.9%, and 85.4% of the procedures of each technique subject to multiple procedure payment reduction, respectively. The projected reimbursement for these studies was $1,666,437, which translated to a $179,782 (12.1%) increase in revenue comparing 25%-versus-5% multiple procedure payment reduction rates for 5 months: $128,542 for CT, $47,802 for MR imaging, and $3439 for ultrasound. The annual overall prorated increase in revenue would be $431,476. The impact was maximal for neuroradiology. With the recent favorable adjustment in multiple procedure payment reduction regulations, CT-heavy subspecialties like neuroradiology benefit the most with revenue increases. Different practice settings might experience revenue increases to a different extent, depending on the procedure and payer mix.

Changes in the diagnosis and treatment of soft tissue sarcoma in Japan, 1977–2016

The treatment of soft tissue tumors has maderemarkable progress through advancements in diagnostic imaging and analysis ofsurgical materials. Changes in the treatment of soft tissue tumors are describedfrom my experience since 1977. Prior to the introduction of CT scans, radiography and angiography were the only methods for tumor localization. Wholebody CT, echography, and soft tissue radiography were introduced around 1980,and significant progress was seen in the localization of soft tissue tumors.Although the localization and diagnostic characteristics of tumors becameeasier with the introduction of MRI, radiography and ultrasound still remainedthe primary diagnostic method for soft tissue tumors. Since 1980, preoperative needle biopsy hasbecome a powerful diagnostic procedure by combining rapid cytological andpathological diagnosis at the Cancer Institute Hospital.The curative wide resection method, based on barrier theory, was an index forpreoperative planning. In addition, with the advent of evaluation methods forsurgical margins, the curability of wide resections can be discussed on acommon platform to open new possibilities in limited resection. However,because current evaluation methods for surgical margins were based onmacroscopic findings, diagnostic measures for invasive sarcomas are stillneeded in future investigations. The development of In Situ Preparation (ISP) isuseful for acquiring information that cannot be obtained with preoperativeimages as it allows for intraoperative evaluation of margins without the riskof tumor contamination, and the surgical technique could be consideredessential for limited resection. In most areas, the preservation of affectedlimbs was made possible by combining ISP with vascular reconstruction, flaptransplantation, joint arthroplasty, bone grafting, among other techniques. Inorder to improve the outcome for the treatment of sarcoma, which is a rarecancer, it is essential to consolidate facilities.

Congenital cystic adenomatoid malformation - diagnostic and therapeutic procedure: 8-year experience of one medical centre.

IntroductionCongenital cystic adenomatoid malformation (CCAM) is a rare anomaly. The mechanisms and the time at which the abnormality develops are still unclear. The malformation is characterized by the presence of single large or multiple but smaller cysts.AimTo present the experience of our medical centre, the Polish Mother’s Memorial Hospital – Research Institute.Material and methodsWe analysed the medical records of 32 neonates hospitalized in 2008–2017 at the Department of Paediatric Surgery and Urology ICZMP due to pre- or postnatally diagnosed congenital cystic adenomatoid malformation.ResultsIn 2008–2017 32 children were hospitalized at our department due to prenatally diagnosed CCAM. An intrauterine procedure of thoracoamniotic shunting was performed in 13 fetuses. All newborns had chest computed tomography. Surgery had been performed in 21 children. Histopathological analysis of specimens prepared from the resected lung tissue confirmed type 1 CCAM in 4 cases, type 2 CCAM in 11 cases and type 3 CCAM in 1 case. Four patients were diagnosed with a bronchogenic cyst and one with extralobar pulmonary sequestration.ConclusionsPostnatal management of CCAM depends on the clinical status of the newborn. Newborns without clinical symptoms require radiological diagnostics to confirm the presence of malformation. Surgical treatment is recommended before the age of 10 months. Resection of the malformed lung fragment in patients with CCAM is the first-line treatment. It should be emphasized that despite the tremendous advances in diagnostic imaging, the final diagnosis of CCAM is made based on histopathological findings.

New Imaging Techniques in Prostate Cancer.

Rapid advances in diagnostic imaging have been developed in parallel with the changes in the contemporary management of prostate cancer. Increasingly, clinical management and decision making in prostate cancer are influenced by technologies such as magnetic resonance imaging-targeted prostate biopsies for men with elevated PSA, imaging for active surveillance, and nuclear medicine studies for men with advanced or recurrent prostate cancer. Furthermore, novel imaging techniques have been developed such as hyperpolarized MRI, choline and prostate-specific membrane antigen positron emission tomography that exploit features like the unique metabolism in prostate cancer tissues, as well as altered glycoprotein conformation. These technologies have allowed for the identification of tiny foci of prostate cancer in men with early biochemical recurrence, greatly surpassing the limitations of traditional morphological imaging. With promising findings, studies are ongoing to uncover the clinical application of these imaging modalities. Ultimately, several factors such as cost-effectiveness and the overall reduction in disease mortality will dictate the implementation of these imaging technologies in the future. This chapter provides an overview on new and emerging prostate imaging techniques that can be used in the diagnosis of primary cancer as well as the staging and detection of metastatic disease.

Trends in the utilization of advanced diagnostic imaging and lumbar disc disorders diagnosis in the Warmia and Mazury Province, Poland

1. Sąsiadek M, Hendrich B. [Diagnostic imaging of the spine, including new imaging techniques]. Pol Przegl Neurol. 2010;6(1):38–45 [in Polish]. Google Scholar

Software-guided predictable endodontic management of three-rooted lower right second premolar

It is essential in endodontics to understand the morphological anatomy of the roots and root canal systems of the teeth to increase the success rate of root canal therapy. Advanced diagnostic imaging modalities like cone-beam computed tomography (CBCT) and the assistive software like three-dimensional (3D) Endo Software (by Dentsply Sirona) are very helpful aids in understanding the anatomy of the teeth, especially the complicated premolars. Most commonly mandibular first and second premolars have a single root and root canal system. However, multiple roots and canals have also been reported in few cases which are considered as a challenging task for an endodontist. The present case report discusses the complete endodontic management of a three-rooted mandibular second premolar using CBCT imaging and assistive guidance by 3D Endo Software (by Dentsply Sirona).

Prevention of kidney cancer incidence and recurrence: lifestyle, medication and nutrition.

The incidence of kidney cancer rises globally with the highest rates in developed countries. This demonstrates the impact of advanced diagnostic imaging but also rising prevalence of modifiable risk factors such as smoking, obesity and hypertension. A literature search was performed with focus on recent studies on risk factors related to lifestyle, medication and nutrition. Further we searched for the effect of cancer prevention strategies. Overall, we included 76 studies of the past 5 years. Based on current evidence smoking tobacco, obesity and hypertension remain established risk factors for kidney cancer. Certain analgesics and consumption of processed meat have been linked to increase development of renal cell carcinoma, although data are limited. Fruits, fiber-rich vegetables, coffee and physical activity may have a protective effect against kidney cancer but causal conclusions are not yet supported. Significantly, there is an increasing evidence of inverse association between moderate alcohol consumption. Overall evidence confirms an effective way to prevent the risk of kidney cancer is maintaining a healthy weight and avoid smoking. State policies should further ensure strategies to raise public awareness and support to adopt healthy lifestyles.

Various congenital anomalies of the inferior vena cava: review of cross-sectional imaging findings and report of a new variant.

The inferior vena cava (IVC) is an important structure receiving a large amount of venous return and is associated with various congenital disorders. Advances in diagnostic imaging and its increasing accessibility have led to an increase in the incidental detection of IVC anomalies. Congenital anomalies of the IVC are not uncommon and are occasionally critical to treatment planning. However, they are frequently overlooked in abdominal imaging. The IVC is composed of four segments (intrahepatic, suprarenal, renal, and infrarenal), and each segment arises from different embryonic structures in a complex process. Anomalies of the IVC can be classified according to the involved segment. Familiarity with the variety of IVC anomalies seen on imaging is vital for correctly diagnosing and managing patients in daily practice.

Characteristics and outcome in patients with non-specific symptoms and signs of cancer referred to a fast track cancer patient pathway; a retrospective cohort study

BackgroundIn 2012 a new cancer patient pathway for patients with non-specific symptoms and signs of cancer (NSSC-CPP) was introduced in Denmark. Limited information is available about the patients referred to the NSSC-CPP and the investigational course. The aim was to describe the population and the investigational course, estimate the prevalence of cancer and one-year mortality, and identify factors associated with a subsequent cancer diagnosis in patients referred to the NSSC-CPP.MethodThis cohort study included patients with at least one visit at the NSSC-CPP at North Zealand Hospital in Denmark (NOH) from October 1st 2013 to September 30th 2014. Data was based on retrospective reviews of the patient files. Logistic regression identified factors associated with a subsequent cancer diagnosis. Multivariate analyses were adjusted by age, gender, smoking status and alcohol consumption. Kaplan-Meier survival plots were made at one-year follow-up.ResultsEight hundred twenty-five patients were included with a median age of 67 years, 47.4% were male. Prevalence of cancer within one year was 16.7% (138/825). 70.3% (97/138) were solid cancers and 29.7% (41/138) were haematological cancers. During the investigational course 76.7% went through advanced diagnostic imaging (ultrasound, CT, FDG-PET/CT or MRI). Anaemia (OR1.63 CI1.02–2.60), leucocytosis (OR 2.06 CI 1.34–3.15), thrombocytopenia (OR 4.13 CI 2.02–8.47) and elevated LDH (OR 1.64 CI 1.07–2.52) and CRP (OR 2.56 CI 1.66–3.95) were associated with a cancer diagnosis when adjusting for possible confounders. No single non-specific symptom was significantly associated with a cancer diagnosis. One-year mortality for those diagnosed with cancer was 44.2%.ConclusionThe prevalence of cancer matches that of another NSSC-CPP in Denmark. Deviations in basic biochemistry were associated with a higher probability of underlying cancer and could possibly raise the level of suspicion of malignancy among physicians. High one-year mortality was seen amongst patients diagnosed with cancer.