Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules

Gould, Michael K.; Sanders, Gillian D; Barnett, Paul G.; Rydzak, Chara E.; Maclean, Courtney C.; McClellan, Mark; Owens, Douglas K

doi:10.7326/0003-4819-138-9-200305060-00009

Cited by 155 publications

(175 citation statements)

References 105 publications

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“…Surgery was slightly more effective when the probability of cancer was > 68%, needle biopsy was preferred when the probability was 3 to 68%, and watchful waiting was preferred when the probability was < 3%. 16 In previous work, 17 we confirmed and extended these findings by showing that it is highly cost-effective to use PET imaging rather than needle biopsy when the probability of cancer falls between 20 and 69%.…”

Section: Discussionsupporting

confidence: 71%

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A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

Gould

Ananth

Barnett

2007

Chest

Self Cite

378

394

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Section: Discussionsupporting

confidence: 71%

“…We and others 16,17 have shown that the effectiveness and cost-effectiveness of strategies for SPN management depend critically on the pretest probability of malignancy. For example, Cummings et al 16 showed that the choice among surgery, needle biopsy, and watchful waiting was a "close call."…”

Section: Discussionmentioning

confidence: 99%

A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

Gould

Ananth

Barnett

2007

Chest

Self Cite

378

394

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show abstract

“…Quantitative models integrating age, smoking history, size of tumors, and other variables were proposed to estimate the likelihood of lung cancer in a particular patient (68,69). The precise cutoff points between which PET should be ordered, and below which lung cancer can be considered ruled out or above which ruled in, were also proposed on the basis of the costeffectiveness analysis (70). Physicians should use their judgment when determining patient risk.…”

Section: Lung Cancer Is 18 F-fdg Pet Useful For Differentiating Benigmentioning

confidence: 99%

Recommendations on the Use of ¹⁸F-FDG PET in Oncology

Fletcher¹,

Djulbegoviĉ²,

Soares³

et al. 2008

J Nucl Med

981

627

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The rationale was to develop recommendations on the use of 18 F-FDG PET in breast, colorectal, esophageal, head and neck, lung, pancreatic, and thyroid cancer; lymphoma, melanoma, and sarcoma; and unknown primary tumor. Outcomes of interest included the use of 18 F-FDG PET for diagnosing, staging, and detecting the recurrence or progression of cancer. Methods: A search was performed to identify all published randomized controlled trials and systematic reviews in the literature. An additional search was performed to identify relevant unpublished systematic reviews. These publications comprised both retrospective and prospective studies of varied methodologic quality. The anticipated consequences of false-positive and false-negative tests when evaluating clinical usefulness, and the impact of 18 F-FDG PET on the management of cancer patients, were also reviewed. Results and Conclusion: 18 F-FDG PET should be used as an imaging tool additional to conventional radiologic methods such as CT or MRI; any positive finding that could lead to a clinically significant change in patient management should be confirmed by subsequent histopathologic examination because of the risk of false-positive results. 18 F-FDG PET should be used in the appropriate clinical setting for the diagnosis of head and neck, lung, or pancreatic cancer and for unknown primary tumor. PET is also indicated for staging of breast, colon, esophageal, head and neck, and lung cancer and of lymphoma and melanoma. In addition, 18 F-FDG PET should be used to detect recurrence of breast, colorectal, head and neck, or thyroid cancer and of lymphoma. PET is an imaging technique that provides unique information about the molecular and metabolic changes associated with disease. The technology has existed for more than 30 years but has been used clinically for only the last 10-15 years. In this period, dramatic improvements in technology, the routine availability of medical cyclotrons (to produce the necessary short-lived positron emitters), and favorable reimbursement decisions in the late 1990s have led to a tremendous increase in the use of this technology. The major area of clinical application is currently in oncology, with some application in cardiology and neurology.PET requires the use of molecules (radiopharmaceuticals) that are labeled with radioactive nuclides. The amounts of radiolabeled material administered are extremely small (10 26 -10 29 g) and have essentially no pharmacologic effect. In this regard, PET has the unique ability to assess molecular alterations associated with disease without perturbing or altering the fundamental underlying molecular and biochemical processes. Although the number of molecular probes that can be radiolabeled with positron emitters is extremely large, and clinical investigational uses number in the thousands, clinical practice has been limited principally to the use of a glucose analog labeled with the positron emitter 18 F-FDG. 18 F-FDG was first synthesized in 1978 (1) and has become the most commonly used radioph...

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“…57 Among patients with indeterminate nodules (by CT scan) and high pretest probability, negative PET scan results do not reliably exclude malignancy. However, FDG uptake in the primary tumor has been shown to be inversely correlated with survival, 58,59 and patients with nonhypermetabolic malignant tumors may have a favorable prognosis, even when defi nitive surgical treatment is delayed by a period of observation as long as 238 days.…”

Section: Shared Decision-making and Patient Preferencesmentioning

confidence: 99%

“…Biopsy was the recommended strategy when the probability of malignancy fell between 3% and 68%. A management algorithm that is based in part on this analysis and a subsequent cost-effectiveness analysis 57 is presented in Figure 1 . More-specifi c recommendations are outlined next.…”

Section: Management Strategiesmentioning

confidence: 99%

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Gould

Donington

Lynch

et al. 2013

Chest

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1,165

1,089

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we suggest that no additional diagnostic evaluation need be performed (Grade 2C) .Remark : This recommendation applies only to solid nodules. For guidance about follow-up of subsolid nodules, see Recommendations 6.5.1 to 6.5.4 . 2.3.3.In the individual with an indeterminate nodule that is identifi ed by chest radiography, we recommend that CT of the chest should be performed (preferably with thin sections Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure . 8 mm in diameter, solid nodules that measure Յ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefi ts and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. CHEST 2013; 143(5)(Suppl):e93S-e120SAbbreviations: AAH 5 atypical adenomatous hyperplasia; ACCP 5 American College of Chest Physicians; AIS 5 adenocarcinoma in situ; EBUS 5 endobronchial ultrasound; ENB 5 electromagnetic navigation bronchoscopy; FDG 5 fl uorodeoxyglucose; HU 5 Hounsfi eld unit; LR 5 likelihood ratio; SPECT 5 single-photon emission CT; TBB 5 transbronchial biopsy; TTNB 5 transthoracic needle biopsy; VATS 5 video-assisted thoracic surgery; VBN 5 virtual bronchoscopy navigation; VDT 5 volume doubling time

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Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules

Cited by 155 publications

References 105 publications

A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

Recommendations on the Use of ¹⁸F-FDG PET in Oncology

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

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Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules

Cited by 155 publications

References 105 publications

A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

A Clinical Model To Estimate the Pretest Probability of Lung Cancer in Patients With Solitary Pulmonary Nodules

Recommendations on the Use of 18F-FDG PET in Oncology

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

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Product

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Recommendations on the Use of ¹⁸F-FDG PET in Oncology