Implementation of diagnostic resources for cancer in developing countries: a focus on PET/CT

Abstract

Positron emission tomography in conjunction with computed tomography (PET/CT) is a relatively novel diagnostic tool which has been proven to be clinically useful in various neoplasms. Currently, only a handful of developing countries have PET/CT capabilities, and in those that do units are mostly located in large urban areas, which limits their availability. The implementation of PET/CT units in low-and-middle income countries is hampered by their high cost, the difficulties associated with their operation, and the limited availability of trained personnel. Furthermore, although the clinical appropriateness of PET/CT is well defined in many scenarios, little is known about its cost-effectiveness, particularly in settings with limited resources. Here, we provide a brief overview of the challenges associated with the implementation of PET/CT in resource-limited settings, including some examples of available data on its cost-effectiveness.

Development of a predictive radiomics model for lymph node metastases in pre-surgical CT-based stage IA non-small cell lung cancer

“…Nevertheless, the misdiagnosis [6] and the false-negative rate [7] still remain a matter of concern. Moreover, the relatively high costs of a PET-CT scan cannot be afforded by many patients in the developing countries [8]. Pathologyrelated biopsy and thoracoscopy evaluate the LN staging better than radiological images, however, these would be invasive procedures for the patients [9,10].…”

Development and evaluation of a venous computed tomography radiomics model to predict lymph node metastasis from non-small cell lung cancer

“…In addition, PET-CT is unaffordable for most patients, especially in underdeveloped and developing countries, which also limits its large-scale clinical application. [ 11 ] Therefore, a noninvasive and cost-effective evaluation tool is needed to predict whether there is LNM in primary lung cancer patient.…”

FDG PET‐CT in pediatric Langerhans cell histiocytosis

“…Although we have shown FDG PET‐CT to be useful in the detection of LCH, its use remains limited in low‐and‐middle‐income countries due to cost, operational difficulties, and lack of availability of trained personnel . Where available, the units are mostly located in larger urban areas, further limiting access .…”

“…Although we have shown FDG PET‐CT to be useful in the detection of LCH, its use remains limited in low‐and‐middle‐income countries due to cost, operational difficulties, and lack of availability of trained personnel . Where available, the units are mostly located in larger urban areas, further limiting access . According to the World Health Organization's Global Access of Medical Devices, 3% of upper‐middle‐income and 4% of lower‐middle‐income countries own at least one PET scanner per million people, compared with 29% in high‐income countries .…”

“…Where available, the units are mostly located in larger urban areas, further limiting access . According to the World Health Organization's Global Access of Medical Devices, 3% of upper‐middle‐income and 4% of lower‐middle‐income countries own at least one PET scanner per million people, compared with 29% in high‐income countries . FDG PET‐CT is unlikely to be available or cost‐effective in settings with reduced resources.…”