Details

Autor(en) / Beteiligte

• Gilbert, Fiona J
• Harris, Scott
• Miles, Kenneth A
• Weir-McCall, Jonathan R
• Qureshi, Nagmi R
• Rintoul, Robert Campbell
• Dizdarevic, Sabina
• Pike, Lucy
• Sinclair, Donald
• Shah, Andrew
• Eaton, Rosemary
• Jones, Jeremy
• Clegg, Andrew
• Benedetto, Valerio
• Hill, James
• Cook, Andrew
• Tzelis, Dimitrios
• Vale, Luke
• Brindle, Lucy
• Madden, Jackie
• Cozens, Kelly
• Little, Louisa
• Eichhorst, Kathrin
• Moate, Patricia
• McClement, Chris
• Peebles, Charles
• Banerjee, Anindo
• Han, Sai
• Poon, Fat-Wui
• Groves, Ashley M
• Kurban, Lutfi
• Frew, Anthony
• Callister, Matthew E J
• Crosbie, Phil A
• Gleeson, Fergus Vincent
• Karunasaagarar, Kavitasagary
• Kankam, Osei
• George, Steve

Titel

Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Ist Teil von

• Thorax, 2022-10, Vol.77 (10), p.988-996

Ort / Verlag

England: BMJ Publishing Group Ltd and British Thoracic Society

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration number NCT02013063