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Consensus on Cancer of Unknown Primary diagnostics for legitim incidence comparison: an expert-based Delphi Study

Status: Article in preparation for submission.

The use of diagnostic tools is essential regarding the CUP (Cancer of Unknown Primary) diagnosis, which is estimated to be 3-5% of all cancers worldwide. Since there is no international consensus on the diagnostic workup, it is hard to determine the exact incidence rates of CUP. This study aims to build consensus on diagnostic techniques to make the understanding of CUP incidence and survival rates more comparable in different countries, in order to improve healthcare and survival of CUP patients from there. A Delphi study, consisting of four surveys, was conducted using 70% as the cut-off value for consensus. Potential participants, 90 in total, were selected via a literature search or via the network of the supervisor, and invited for participation via e-mail. A global panel of 30 experts completed the Delphi study. Experts agreed on a categorical system, consisting of an initial, supplemental, and advanced diagnostic workup. Experts agreed on the diagnostics making up the initial diagnostic workup, but did not reach consensus on the tools for the supplemental and advanced diagnostic workup. In addition, consensus was reached on a multidisciplinary CUP team consisting of at least an oncologist, a pathologist, and a radiologist to make the CUP diagnosis. In conclusion, consensus was reached on a categorical workup scheme for the diagnostic definition of CUP. The categorical scheme enables the comparison of CUP patient populations between countries, and helps to develop better healthcare for CUP patients.