TOPLINE:

CT scans identified cancer in 13% of patients with non-specific symptoms, despite a fivefold increase in referrals from GPs from 2012 to 2019. Around 1 in 7 patients were diagnosed with cancer.

METHODOLOGY:

• This retrospective cohort study was conducted in a region of Denmark to assess the prevalence of cancer, diagnostic accuracy of CT scans in detecting cancer, and changes in referral patterns in adult patients referred for CT scans due to non-specific symptoms of cancer.
• The referrals were made by GPs from July to December 2019, and patients were followed up for up to 12 months post-CT scan to track cancer diagnoses.
• Contrast-enhanced CT scans of the chest, abdomen, and pelvis were performed, and scans were reviewed by radiologists.
• Radiologic findings from CT scans were categorised into four groups: no cancer or abnormalities, no suspicions of cancer but other findings needing further investigation, possible cancer, and probable cancer.
• GP-reported symptoms and clinical findings at the time of referral were extracted from the referrals. True-positive and true-negative results were defined on the basis of radiologic findings and cancer diagnosis within 12 months.

TAKEAWAY:

• A total of 729 patients were included; a fivefold increase in referrals for CT scans was observed from 2012 to 2019.
• Overall, 13% of patients were diagnosed with cancer, with pancreatic cancer (17%), lung cancer (14%), and haematologic cancer (13%) being the most common. The negative likelihood ratio was 0.15.
• During the 12-month follow-up period, death was reported in 52 patients, of whom 37 (65%) were diagnosed with cancer.
• Among symptoms and signs reported by the GP at referral, GPs' "gut feeling" of cancer was reported in 19% of cases, with age, anaemia, and GPs' "gut feeling" being significant predictors of malignancy (P < .005 for all).

IN PRACTICE:

"Our data show that GP use of ceCT-TAP [contrast-enhanced CT of the thorax, abdomen, and pelvis] in the NSSC-CPP [Cancer Patient Pathway for Non-specific Symptoms and Signs of Cancer] has increased markedly since 2012, reflecting earlier recognition of suspicious symptoms and possibly increased clinical confidence in referral pathways," the authors wrote. "However, because a normal ceCT-TAP does not convincingly rule out cancer (LR- [negative likelihood ratio] >0.1), it should not be used in isolation. Clinical judgement, patient history, physical examination, and complementary investigations remain essential," they added.

SOURCE:

This study was led by Mads Rømer Skøtt, Department of Internal and Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark. It was published online on November 05, 2025, in BJGP Open.

LIMITATIONS:

Symptoms reported by GPs at the time of referral for CT scans may not have accurately represented patient-reported symptoms. The absence of access to GP medical records could have led to missing clinical findings. Referral bias may have affected symptom reporting as GPs might emphasise symptoms more likely leading to accepted referrals.

DISCLOSURES:

The authors did not declare any specific funding for this research. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.