Health care utilization and management patterns of asymptomatic incidental pulmonary embolism in cancer patients.

Abstract

e13562 Background: Asymptomatic incidental pulmonary embolism (iPE) is increasingly detected in cancer patients on routine imaging; however, the optimal management setting and real-world data on healthcare utilization remain poorly defined. Methods: We conducted a retrospective cohort pilot study of cancer patients with newly diagnosed iPE detected on routine imaging in the outpatient setting at MD Anderson Cancer Center. AI-assisted imaging review (Aidoc) identified CT scans with iPE from 9/29/2025 to 11/09/2025 and were manually confirmed. Asymptomatic iPE was defined as the absence of symptoms associated with PE such as chest pain, dyspnea, and cough. The primary endpoint was acute care utilization following diagnosis, defined as outpatient vs acute care setting (emergency department/urgent care/observation/inpatient). Secondary endpoints were time to anticoagulation (AC), time of radiologist notification, and 30-day clinical outcomes. Fisher’s exact and chi-squared tests were used to compare categorical variables. Results: Cancer patients with iPE (n = 153) were identified and 92% (n = 141) were asymptomatic (median age 64; 51% female, 51% gastrointestinal malignancy). Presence of symptoms was associated with management of iPE in the acute care setting (p < 0.001). Asymptomatic iPE patients were managed as outpatient (77%) or in the acute care setting (23%; emergency department 11%, urgent care 5%, observation 4%, inpatient 3%). BNP/Troponins (17%) and echocardiograms (11%) were obtained in patients, primarily in the acute care setting. iPE extent was categorized as distal (subsegmental, segmental; 87%) or proximal (central, lobar; 13%) but was not associated with acute care setting (p = 0.24). Radiologist notification of iPE occurred in the morning (8AM-12PM; 35%), afternoon (12PM-5PM; 43%), or after hours (5PM-8AM; 22%). Acute care management of asymptomatic iPE occurred in the morning (12%), afternoon (28%), and after hours (29%) (p = .096). AC was used in 97% (n = 137) of asymptomatic iPE patients. 12% of asymptomatic iPE patients were already on AC. AC was initiated within the same day of diagnosis in 70% and within two days in 94% of asymptomatic iPE patients. AC occurred within the same day in 66% outpatient vs 83% in the acute care patients (p = 0.11). Within 30 days, all cause mortality was 1% among outpatients compared with 6% in the acute care group, while recurrent VTE occurred in 2% vs 6%, respectively. Conclusions: In this pilot study, nearly one quarter of patients with asymptomatic iPE underwent acute care management. These results highlight substantial practice variation in the management of iPE and suggest further exploration of standardized outpatient pathways.