Paula Ghaneh1, Robert Hanson2, Andrew Titman3, Gill Lancaster3, Catrin Plumpton4, Huw Lloyd-Williams4, Seow Tien Yeo4, Rhiannon Tudor Edwards4, Colin Johnson5, Mohammed Abu Hilal6, Antony P Higginson7, Tom Armstrong6, Andrew Smith8, Andrew Scarsbrook9, Colin McKay10, Ross Carter10, Robert P Sutcliffe11, Simon Bramhall12, Hemant M Kocher13, David Cunningham14, Stephen P Pereira15, Brian Davidson16, David Chang17, Saboor Khan18, Ian Zealley19, Debashis Sarker20, Bilal Al Sarireh21, Richard Charnley22, Dileep Lobo23, Marianne Nicolson24, Christopher Halloran1, Michael Raraty25, Robert Sutton25, Sobhan Vinjamuri26, Jonathan Evans27, Fiona Campbell28, Jon Deeks29, Bal Sanghera30, Wai-Lup Wong30, John P Neoptolemos1. 1. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. 2. Liverpool Cancer Research UK Cancer Trials Unit, University of Liverpool, Liverpool, UK. 3. Department of Mathematics and Statistics, Lancaster University, Lancaster, UK. 4. Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK. 5. Faculty of Medicine, University of Southampton, Southampton, UK. 6. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 7. Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK. 8. Department of Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 9. Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 10. Department of Surgery, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK. 11. Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 12. Department of General Surgery, Wye Valley NHS Trust, Hereford, UK. 13. Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, UK. 14. Gastrointestinal and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK. 15. Institute for Liver and Digestive Health, University College London Hospitals NHS Foundation Trust, London, UK. 16. Department of Surgery, Royal Free London NHS Foundation Trust, London, UK. 17. Department of Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK. 18. Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. 19. Department of Surgery, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. 20. Department of Oncology, King's College Hospital NHS Foundation Trust, London, UK. 21. Department of Surgery, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK. 22. Department of Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 23. Faculty of Medicine and Life Sciences, University of Nottingham, Nottingham, UK. 24. Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK. 25. Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. 26. Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. 27. Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. 28. Department of Pathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. 29. Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 30. Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
Abstract
BACKGROUND: Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. OBJECTIVE: To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. DESIGN: A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. PARTICIPANTS: Patients with suspected pancreatic malignancy. INTERVENTIONS: All patients to undergo PET/CT following standard diagnostic work-up. MAIN OUTCOME MEASURES: The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. RESULTS: Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. CONCLUSION: PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. STUDY REGISTRATION: Current Controlled Trials ISRCTN73852054 and UKCRN 8166. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
BACKGROUND:Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. OBJECTIVE: To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. DESIGN: A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. PARTICIPANTS: Patients with suspected pancreatic malignancy. INTERVENTIONS: All patients to undergo PET/CT following standard diagnostic work-up. MAIN OUTCOME MEASURES: The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. RESULTS: Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. CONCLUSION: PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. STUDY REGISTRATION: Current Controlled Trials ISRCTN73852054 and UKCRN 8166. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
Authors: Christopher Gromisch; Motaz Qadan; Mariana Albuquerque Machado; Kebin Liu; Yolonda Colson; Mark W Grinstaff Journal: Cancer Res Date: 2020-03-27 Impact factor: 12.701
Authors: Chad A Barnes; Mohammed Aldakkak; Callisia N Clarke; Kathleen K Christians; Daniel Bucklan; Michael Holt; Parag Tolat; Paul S Ritch; Ben George; William A Hall; Beth A Erickson; Douglas B Evans; Susan Tsai Journal: Front Oncol Date: 2020-04-17 Impact factor: 6.244
Authors: Yang Chen; Li Wang; Shi Luo; Jun Hu; Xing Huang; Pei-Wen Li; Yi Zhang; Chao Wu; Bo-Le Tian Journal: Drug Des Devel Ther Date: 2020-07-23 Impact factor: 4.162
Authors: Florian N Loch; Patrick Asbach; Matthias Haas; Hendrik Seeliger; Katharina Beyer; Christian Schineis; Claudius E Degro; Georgios A Margonis; Martin E Kreis; Carsten Kamphues Journal: World J Surg Oncol Date: 2020-08-18 Impact factor: 2.754
Authors: Bart Cornelissen; James C Knight; Somnath Mukherjee; Laura Evangelista; Catarina Xavier; Federico Caobelli; Silvana Del Vecchio; Latifa Rbah-Vidal; Jacques Barbet; Marion de Jong; Fijs W B van Leeuwen Journal: Eur J Nucl Med Mol Imaging Date: 2018-09-17 Impact factor: 9.236
Authors: R Pandé; J Hodson; A Murray; F Marcon; M Kalisvaart; R Marudanayagam; R P Sutcliffe; D F Mirza; J Isaac; K J Roberts Journal: BJS Open Date: 2019-04-02