Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers

• Published in: Health technology assessment (Winchester, England) England), 2007-10, Vol.11 (44), p.iii-iv
• Main Authors: Facey, K, Bradbury, I, Laking, G, Payne, E
• Format: Article
• Language: English
• Subjects: Breast Neoplasms; Clinical Trials as Topic; Colorectal Neoplasms; Cost-Benefit Analysis; Databases, Bibliographic; Decision Support Techniques; Esophageal Neoplasms; Head and Neck Neoplasms; Humans; Lymphoma; Melanoma; Neoplasms - diagnostic imaging; Neoplasms - therapy; Outcome and Process Assessment (Health Care); Positron-Emission Tomography - instrumentation; Thyroid Neoplasms; United Kingdom
• ISSN: 1366-5278; 2046-4924; 1366-5278
• DOI: 10.3310/hta11440

To assess the clinical effectiveness of positron emission tomography (PET) using 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in breast, colorectal, head and neck, lung, lymphoma, melanoma, oesophageal and thyroid cancers. Management decisions relating to diagnosis, staging/restaging, recurrence, treatment response and radiotherapy (RT) planning were evaluated separately. Major electronic databases were searched up to August 2005 and a survey of UK PET facilities was performed in February 2006. This assessment augments the systematic search undertaken in a previous review. Studies were limited to those using commercial dedicated PET or PET/computed tomography (CT) devices with FDG, in one of the eight cancers. The new search identified six systematic reviews and 158 primary studies. An economic model for England showed that in non-small cell lung cancer (NSCLC) FDG-PET was cost-effective in CT node-negative patients, but not in CT node-positive patients. A less robust model also showed that FDG-PET was cost-effective in RT planning for NSCLC. A model for Scotland showed that in late-stage Hodgkin's lymphoma (HL), FDG-PET was cost-effective for restaging after induction therapy. For staging/restaging colorectal cancer, FDG-PET changed patient management in a way that can impact on curative therapy. For detection of solitary pulmonary nodule (SPN) there was also impact on patient management, but the resulting effect on patient outcomes was unclear. FDG-PET had an impact on patient management across paediatric lymphoma decisions, but further study of individual management decisions is required. For other cancer management decisions, the evidence on patient management is weak. FDG-PET was accurate in detecting distant metastases across several sites, but sensitivity was variable for detection of lymph-node metastases and poor in early stage disease where sentinel lymph-node biopsy would be used and for small lesions. There were 61 studies of treatment response. These were generally small and covered all cancers except melanoma. They showed that FDG-PET imaging could be correlated with response, in some cases, but the impact on patient management was not documented. There were 17 small studies of RT planning in four cancers; here, FDG-PET led to alteration of RT volumes and doses, but the impact on patient outcomes was not studied. FDG-PET improved diagnostic accuracy compared with alternatives in a number of other cancer management decisions, but more comparative ev