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Routine vs Extensive Malignancy Search for Adult Dermatomyositis and Polymyositis
A Study of 40 Patients
Agnès Sparsa, MD;
Eric Liozon, MD;
François Herrmann, MD, MPH;
Kim Ly, MD;
Valérie Lebrun, MD;
Pascale Soria, MD;
Véronique Loustaud-Ratti, MD;
Marie-Laure Bouyssou-Gauthier, MD;
Serge Boulinguez, MD;
Christophe Bédane, MD, PhD;
Marie-Odile Jauberteau, MD, PhD;
Elisabeth Vidal, MD;
Jean-Marie Bonnetblanc, MD
Arch Dermatol. 2002;138:885-890.
Objective To identify potential risk factors and the yield of routine screens
for early detection of malignancy associated with dermatomyositis (DM) and
polymyositis (PM).
Design Retrospective study of malignancies in all patients with DM or PM followed
up between the years 1981 and 2000 and a review of the relationship of DM
and PM to malignancy, the usefulness of various tests or examinations for
malignancy search, and the patients' course.
Setting Departments of internal medicine and dermatology in a teaching hospital.
Patients Forty consecutive adult patients with DM (33 cases) or PM (7 cases).
Main Outcome Measures (1) Rate of false-negative results of routine workup and yield (percentage
of positive results) of blind malignancy search and (2) comparison of 16 characteristics
in patients with malignancy vs those without.
Results Malignancy occurred in 16 patients: 13 with DM and 3 with PM. In all
cases, the diagnosis of malignancy was made concurrently with or shortly after
the diagnosis of DM or PM. Factors associated with malignancy were recruitment
in the internal medicine department (P = .02), constitutional
symptoms (P<.01), a rapid onset of DM or PM (P = .02), the lack of Raynaud phenomenon (P< .01), and a higher mean erythrocyte sedimentation rate (P<.01) and creatine kinase level (P<.01). Initial routine search failed to discover 4 malignancies,
3 of which were discovered at an advanced stage by more extensive investigations.
The positive result yield of blind malignancy search was only 13% (11 of 87),
but reached 28% (5 of 18) for blind abdominal-pelvic and thoracic computed
tomographic scans.
Conclusion Extensive search for malignancy, particularly computed tomographic scans,
may be warranted in at least a subset of patients with DM or PM and risk factors
of malignancy.
From the Departments of Dermatology (Drs Sparsa, Lebrun, Bouyssou-Gauthier,
Boulinguez, Bédane, and Bonnetblanc) and Internal Medicine (Drs Liozon,
Ly, Soria, Loustaud-Ratti, and Vidal), and the Immunology Laboratories (Dr
Jauberteau), University Hospital of Limoges, Limoges, France; and the Department
of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland (Dr Herrmann).
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