Clinician-selected CT in a non-site-specific rapid diagnostic pathway: diagnostic performance and incidental disease burden
In brief
Three in four cancer-suspicious CTs were confirmed in a rapid diagnostic pathway
In this single-centre study, clinician-selected CT was suspicious for cancer in 44 of 405 patients scanned; 33 of those patients were diagnosed with cancer. CT sensitivity was 97%, and 99 scans also showed clinically significant non-cancer findings. Without a comparison pathway or cost data, the study cannot show whether CT is best arranged in the diagnostic centre or primary care.
- Journal
- Journal of cancer policy (Q1)
- Published
- 6 November 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Edward Antram, Connor Holmes, Borna Sayed Farzaneh, Sarah Naunton, Abigail Attree, Matthew Smith, et al.
- PMID
- 42994564
- DOI
- 10.1016/j.jcpo.2026.100829
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 8 November 2026): CT diagnostic performance in a cancer pathway
Abstract
BACKGROUND: Non-site-specific rapid diagnostic centres (NSS-RDCs) assess patients with non-specific symptoms that may indicate cancer. Most undergo CT, but its role after clinician-led assessment is uncertain. We evaluated whether clinician-selected CT identifies malignancy in this setting and quantified its diagnostic performance and the burden of clinically significant non-malignant disease. METHODS: Single-centre retrospective cohort using a prospectively maintained NSS-RDC database in London, UK. Consecutive adults referred between December 2020 and March 2022 were eligible. Referrals redirected to site-specific pathways at triage were excluded. Remaining patients underwent clinical assessment before CT selection. CT was deemed positive when the radiology report expressed suspicion of cancer. Primary outcome was cancer diagnosed within six months from multidisciplinary team records. RESULTS: Of 677 referrals, 502 were included (median age 66 years; 42% male), of whom 35 (7.0%) were diagnosed with cancer within 6 months. After clinician review, 405/502 (80.7%) underwent CT. Cancer was suspected in 44 scans (10.9%) and confirmed in 33 (75.0%). CT sensitivity was 97.1% (95% CI 85.1-99.5), specificity 97.0% (94.8-98.3), positive predictive value 75.0% (60.6-85.4) and negative predictive value 99.7% (98.4-100). Of 35 cancers, 34 occurred in patients selected for CT. Clinically significant non-malignant findings were present in 99 scans (24.4%). Median time to diagnosis or exclusion of cancer was 37 days. CONCLUSION: Clinician-selected CT within an NSS-RDC identified almost all cancer diagnosed within six months, and three quarters of scans reported as suspicious were confirmed. Approximately one quarter demonstrated a clinically significant non-malignant finding. POLICY SUMMARY: NSS-RDC pathways identify cancer while generating follow-up activity for non-malignant findings. Without a comparator pathway or cost data, the findings cannot determine whether CT is better arranged within the NSS-RDC or in primary care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.