The optimal timing of FDG-PET/CT in non-small cell lung cancer diagnosis and staging in an Australian centre.
Adenocarcinoma
/ diagnostic imaging
Aged
Australia
Biopsy
Carcinoma, Non-Small-Cell Lung
/ diagnostic imaging
Cost-Benefit Analysis
Decision Trees
Female
Fluorodeoxyglucose F18
Humans
Logistic Models
Lung Neoplasms
/ diagnostic imaging
Male
Middle Aged
Multimodal Imaging
/ economics
Neoplasm Metastasis
Neoplasm Staging
Positron-Emission Tomography
Radiopharmaceuticals
Retrospective Studies
Tomography, X-Ray Computed
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
01 Jul 2021
01 Jul 2021
Historique:
received:
10
03
2021
accepted:
31
05
2021
entrez:
2
7
2021
pubmed:
3
7
2021
medline:
30
11
2021
Statut:
epublish
Résumé
Clinical practice guidelines and re-imbursement schedules vary in the recommended timing of FDG-PET/CT in the diagnostic evaluation of suspected or confirmed lung cancer. The aim was to estimate the probability of requiring more than one invasive test to complete diagnosis and staging in non-small cell lung cancer if FDG-PET/CT was used prior to initial biopsy (FDG-PET/CT First) compared to current Australian funding criteria (CT First). Single-centre retrospective study of individuals with pathologically confirmed NSCLC without evidence of metastatic disease on baseline computed tomography (CT) of the chest. Decision tree analysis based on diagnosis and staging approaches estimated the probability of requiring more than one invasive biopsy. A Monte Carlo analysis with 1000 simulations was used to estimate decision tree precision. After exclusions, 115 patients were included with median (IQR) age of 71 (63-79) and 55.6% were male. The majority of cases were early stage (Stage I 43.5%, Stage II 19.1%) and adenocarcinoma (65.2%) histological subtype. The estimated probability of requiring more than one invasive biopsy with FDG-PET/CT prior was 0.12 compared to 0.19 when using the base case CT First scenario. Using the Monte Carlo analysis, the mean (95% CI) probability using the FDG-PET First approach was 0.15 (95%CI 0.12-0.20) versus 0.20 (95% CI 0.15-0.27) for the CT First approach. Only 7.8% had CT Chest-occult metastatic disease on FDG-PET that was accessible by percutaneous biopsy. FDG-PET/CT performed prior to initial biopsy may reduce the proportion of people with NSCLC who require more than one biopsy attempt, but the clinical significance and overall cost-utility requires evaluation.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical practice guidelines and re-imbursement schedules vary in the recommended timing of FDG-PET/CT in the diagnostic evaluation of suspected or confirmed lung cancer. The aim was to estimate the probability of requiring more than one invasive test to complete diagnosis and staging in non-small cell lung cancer if FDG-PET/CT was used prior to initial biopsy (FDG-PET/CT First) compared to current Australian funding criteria (CT First).
METHODS
METHODS
Single-centre retrospective study of individuals with pathologically confirmed NSCLC without evidence of metastatic disease on baseline computed tomography (CT) of the chest. Decision tree analysis based on diagnosis and staging approaches estimated the probability of requiring more than one invasive biopsy. A Monte Carlo analysis with 1000 simulations was used to estimate decision tree precision.
RESULTS
RESULTS
After exclusions, 115 patients were included with median (IQR) age of 71 (63-79) and 55.6% were male. The majority of cases were early stage (Stage I 43.5%, Stage II 19.1%) and adenocarcinoma (65.2%) histological subtype. The estimated probability of requiring more than one invasive biopsy with FDG-PET/CT prior was 0.12 compared to 0.19 when using the base case CT First scenario. Using the Monte Carlo analysis, the mean (95% CI) probability using the FDG-PET First approach was 0.15 (95%CI 0.12-0.20) versus 0.20 (95% CI 0.15-0.27) for the CT First approach. Only 7.8% had CT Chest-occult metastatic disease on FDG-PET that was accessible by percutaneous biopsy.
CONCLUSION
CONCLUSIONS
FDG-PET/CT performed prior to initial biopsy may reduce the proportion of people with NSCLC who require more than one biopsy attempt, but the clinical significance and overall cost-utility requires evaluation.
Identifiants
pubmed: 34210303
doi: 10.1186/s12890-021-01564-w
pii: 10.1186/s12890-021-01564-w
pmc: PMC8252249
doi:
Substances chimiques
Radiopharmaceuticals
0
Fluorodeoxyglucose F18
0Z5B2CJX4D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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