Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review

BACKGROUND: The best available test for the diagnosis of upper extremity deepvenous thrombosis (UEDVT) is contrast venography. The aim of this systematicreview was to assess whether the diagnostic accuracy of other tests forclinically suspected UEDVT is high enough to justify their use in clinicalpractise and to evaluate if any test can replace venography.METHODS: MEDLINE and EMBASE databases were searched from inception to June 2009. Two reviewers independently evaluated study eligibility, extracted data, andassessed study quality.RESULTS: We identified 17 papers, reporting on 793 patients. Overall, themethodological quality was poor, sample sizes were small, and large between-studydifferences were observed in spectrum and design. The summary estimates ofsensitivity (95% confidence interval) were 97% (90-100%) for compressionultrasonography, 84% (72-97%) for Doppler ultrasonography, 91% (85-97%) forDoppler ultrasonography with compression, and 85% (72-99%) for phleboreography.The corresponding summary estimates of specificity were, respectively, 96%(87-100%), 94% (86-100%), 93% (80-100%), and 87% (71-100%). Clinical findings, a clinical score, D-dimer, magnetic resonance imaging, rheography andplethysmography were evaluated in one study each, involving a median number of 46patients (range 21-214). Sensitivity and specificity ranged from 0% to 100% andfrom 14% to 100%.CONCLUSIONS: Methodological limitations, large between-study differences andsmall sample sizes limit the evidence of tests for clinically suspected UEDVT.Compression ultrasonography may be an acceptable alternative to venography. Theaddition of (color) Doppler does not seem to improve the accuracy. Adequatelydesigned studies are warranted to confirm these findings.