18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Accuracy in the Staging of Non-Small Cell Lung Cancer: Review and Cost-Effectiveness
Aim of the performed clinical study was to compare the accuracy and cost-effectiveness of PET/CT in the staging of non-small cell lung cancer (NSCLC). Material and Methods. Cross-sectional and prospective study including 103 patients with histologically confirmed NSCLC. All patients were examined using PET/CT with intravenous contrast medium. Those with disease stage ≤IIB underwent surgery (). Disease stage was confirmed based on histology results, which were compared with those of PET/CT and positron emission tomography (PET) and computed tomography (CT) separately. 63 patients classified with ≥IIIA disease stage by PET/CT did not undergo surgery. The cost-effectiveness of PET/CT for disease classification was examined using a decision tree analysis. Results. Compared with histology, the accuracy of PET/CT for disease staging has a positive predictive value of 80%, a negative predictive value of 95%, a sensitivity of 94%, and a specificity of 82%. For PET alone, these values are 53%, 66%, 60%, and 50%, whereas for CT alone they are 68%, 86%, 76%, and 72%, respectively. Incremental cost-effectiveness of PET/CT over CT alone was €17,412 quality-adjusted life-year (QALY). Conclusion. In our clinical study, PET/CT using intravenous contrast medium was an accurate and cost-effective method for staging of patients with NSCLC. 1. Introduction Lung cancer is the most common fatal neoplasm in developed countries. Non-small cell lung cancer (NSCLC) is responsible for 80% of all deaths from this neoplasm [1]. Despite all efforts to improve early diagnosis, survival rates remain very low (about 18% at 5 years) [2]. The stage at which NSCLC is detected is the most important of all prognostic factors and the only one that determined treatment options in our study before targeted therapy was administered. The TNM classification of malignant tumors [3] for staging NSCLC is internationally accepted and validated. CT is currently the most commonly used technique in tumor staging. However, results, which are based on normal lymph node size, have limited value. In contrast, PET provides valuable functional information because it can detect metabolically active tumor cells. Over the last 10 years, PET has become an important tool for staging lung cancer, given its high sensitivity in the detection of lymph node involvement and distant metastasis [4] and its current use in presurgical stratification of NSCLC [5]. The combination of CT and PET makes it possible to visualize anatomical and metabolic images together, thus minimising the limitations and maximising the benefits
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