The value of positron emission tomography in patients with non-small cell lung cancer

Abstract

a b s t r a c tBackground: Pre-operative assessment of non-small cell lung cancer (NSCLC) is a major application of positron emission tomography (FDG-PET). Despite substantial evidence of diagnostic accuracy, relatively little attention has been paid to its effects on patient outcomes. This paper addresses this by extending an existing decision model to include patient-elicited utilities. Patients and methods:A decision-tree model of the effect of FDG-PET on pre-operative staging was converted to a Markov model. Utilities for futile and appropriate thoracotomy were elicited from 75 patients undergoing staging investigation for NSCLC. The decision model was then used to estimate the expected value of perfect information (EVPI) associated with three sources of uncertainty-the accuracy of PET, the accuracy of CT and the patient related utility of a futile thoracotomy. Results: The model confirmed the apparent cost-effectiveness of FDG-PET and indicated that the EVPI associated with the utility of futile thoracotomy considerably exceeds that associated with measures of accuracy. Conclusion:The study highlights the importance of patient related utilities in assessing the costeffectiveness of diagnostic technologies. In the specific case of PET for pre-operative staging of NSCLC, future research effort should focus on such elicitation, rather than further refinement of accuracy estimates.

PET/MRI: Where might it replace PET/CT?

“…The fusion of functional information gathered from positron emission tomography (PET) with anatomic information obtained using computed tomography (CT) has led to rapid growth in the use of PET/CT since its introduction to clinical practice. PET/CT systems using 18F‐fluorodeoxyglucose (FDG) PET to measure metabolic activity are both beneficial to patients and cost effective for several oncologic indications and show promise in the evaluation of a wide range of other conditions, including infection/inflammation, cardiac imaging, and neurological function . FDG uptake is an important discriminating factor in the evaluation of potentially malignant cells .…”

A systematic review of PET and PET/CT in oncology: A way to personalize cancer treatment in a cost-effective manner?

“…Some articles provided new decision models. One study converted an existing decision tree to a Markov model [25]. Von Schulthess et al [27] suggest that the cost-effectiveness of integrated PET/CT is superior to that of PET alone in some indications, because of both the higher diagnostic accuracy of integrated PET/CT and the potential for higher patient throughput.…”

“…Kee et al [25] converted an existing decision tree model of the impact of PET on preoperative staging of NSCLC to a Markov model to include patient-elicited utilities. Based on the Markov model, the expected value of perfect information (EVPI) associated with three sources of uncertainty (the accuracy of PET, the accuracy of CT, and the patient-related utility of a futile thoracotomy) was estimated.…”

Ο Ρόλος Των Βιολογικών Παραγόντων Στην Αντιμετώπιση Ασθενών Με Μη Μικροκυτταρικό Καρκίνο Του Πνεύμονα

“…Οι ενδείξεις του σταδιακά επεκτάθηκαν στην διάγνωση, σταδιοποίηση και στην επανασταδιοποίηση μετά από την εφαρμογή θεραπείας για τον πνευμονικό καρκίνο αλλά και σε άλλες νεοπλασίες [63]. Η χρησιμότητα της μεθόδου έχει εκτιμηθεί σε πολλές μελέτες και φαίνεται ότι η αρνητική προγνωστική της αξία φτάνει το 89% στο μεσοθωράκιο και 100% στα επινεφρίδια [64]. Φαίνεται ότι η χρήση του PET/CT στην αρχική σταδιοποίηση των ασθενών μειώνει τον αριθμό των άσκοπων θωρακοτομών [65].…”