Emergency Radiology

, Volume 26, Issue 6, pp 633–638 | Cite as

New CT-based diagnoses of torso cancer is low in the emergency department setting

  • Inessa A. Goldman
  • Alain Cunqueiro
  • Meir H. ScheinfeldEmail author
Original Article



The incidence of new CT-based torso cancer diagnoses and the most commonly diagnosed cancer types in the emergency department (ED) setting are unknown. The purpose of our study was to determine the incidence and types of new CT-based torso cancer diagnoses in the ED.


A total of 19,496 CT reports including all or parts of the torso from 2017 were searched for the keywords: “mass”, “tumor”, “neoplasm”, “malignancy”, or “cancer”. Each report and corresponding medical record was evaluated for presence of a new cancer. Cases were scored as no cancer, subcentimeter lung nodule, known cancer, new cancer, or suspicious, but unconfirmed for new cancer. Each mass was characterized as symptom-related or incidental.


At least one keyword was found in 2086 reports. Of these 706, 126 and 905 were known cancer cases, subcentimeter lung nodules, and non-cancerous cases, respectively. There were 251 confirmed new cancers and 98 suspicious cases which lacked adequate diagnostic workup. Depending on whether only definite or definite and suspicious cases were included together, the number of new cancer cases per 100 torso CT exams was 1.3 or 1.8, respectively. Gastrointestinal, lung, pancreaticobiliary, urinary, and gynecologic cancers were most common. Only 58 of the confirmed cases (23%) were deemed as incidental findings.


CT-diagnosis of new torso cancers was uncommon in our setting. Still, while extensive knowledge of cancer staging may not be necessary for ED radiologists, knowledge of the most common types of cancer including gastrointestinal, lung, pancreaticobiliary, urinary, and gynecologic cancers may improve sensitivity for these diagnoses and may expedite appropriate referrals for the newly diagnosed patients.


Cancer incidence Cancer diagnosis Diagnosis CT Emergency department 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N (2017) Trends in adult Cancer-related emergency department utilization: an analysis of data from the Nationwide emergency department sample. JAMA Oncol 3(10):e172450. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Yang Z, Yang R, Kwak MJ, Qdaisat A, Lin J, Begley CE, Reyes-Gibby CC, Yeung SJ (2018) Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide. PLoS One 13(2):e0191658CrossRefGoogle Scholar
  3. 3.
    Otoni JC, Noschang J, Okamoto TY, Vieira DR, Petry MS, de Araujo Ramos L, Barbosa PN, Bitencourt AG, Chojniak R (2017) Role of computed tomography at a cancer center emergency department. Emerg Radiol 24(2):113–117CrossRefGoogle Scholar
  4. 4.
    Succi, M, Yun, B, Gottumukkala, R, Glover, M, Sonis, J, Dorner, S, White, B, Lev, M, Raja, A, Prabhakar, A (2018) Turning around Cancer: oncologic imaging and implications for emergency radiology workflow. Radiological Society of North America 2018 scientific assembly and annual meeting, Chicago IL. Accessed May 14, 2019
  5. 5.
    Rosenkrantz AB, Hanna TN, Babb JS, Duszak R Jr (2017) Changes in emergency department imaging: perspectives from National Patient Surveys over two Decades. J Am Coll Radiol 14(10):1282–1290CrossRefGoogle Scholar
  6. 6.
    Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995-2007. Radiology. 258(1):164–173CrossRefGoogle Scholar
  7. 7.
    Hsu J, Donnelly JP, Moore JX, Meneses K, Williams G, Wang HE (2018) National characteristics of emergency department visits by patients with cancer in the United States. Am J Emerg Med 36(11):2038–2043CrossRefGoogle Scholar
  8. 8.
    Herbert A, Abel GA, Winters S, McPhail S, Elliss-Brookes L, Lyratzopoulos G (2019) Are inequalities in cancer diagnosis through emergency presentation narrowing, widening or remaining unchanged? Longitudinal analysis of English population-based data 2006-2013. J Epidemiol Community Health 73(1):3–10. CrossRefPubMedGoogle Scholar
  9. 9.
    Clopper CJ, Pearson ES (1934) The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 26:404–413CrossRefGoogle Scholar
  10. 10.
    Guimaraes MD, Bitencourt AG, Marchiori E, Chojniak R, Gross JL, Kundra V (2014) Imaging acute complications in cancer patients: what should be evaluated in the emergency setting? Cancer Imaging 14:18PubMedPubMedCentralGoogle Scholar
  11. 11.
    Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, Richards M (2012) Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. Br J Cancer 107(8):1220–1226CrossRefGoogle Scholar
  12. 12.
  13. 13.
    Razavi SA, Johnson JO, Kassin MT, Applegate KE (2014) The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety. Emerg Radiol 21(6):605–613CrossRefGoogle Scholar
  14. 14.
    Lips LM, Cremers PT, Pickhardt PJ, Cremers SE, Janssen-Heijnen ML, de Witte MT, Simons PC (2015) Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography. Radiology. 275(1):127–135CrossRefGoogle Scholar
  15. 15.
    Fernandes T, Oliveira MI, Castro R, Araújo B, Viamonte B, Cunha R (2014) Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 5(2):195–208CrossRefGoogle Scholar
  16. 16.
    Punjabi GV (2018) Multi-energy spectral CT: adding value in emergency body imaging. Emerg Radiol 25(2):197–204CrossRefGoogle Scholar
  17. 17.
    Yitta S, Hecht EM, Mausner EV, Bennett GL (2011) Normal or abnormal? Demystifying uterine and cervical contrast enhancement at multidetector CT. Radiographics. 31(3):647–661CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Montefiore Medical Center, Department of Radiology, Division of Emergency RadiologyAlbert Einstein College of MedicineBronxUSA

Personalised recommendations