Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
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
Аннотация
METHODS: In 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.
RESULTS: 312 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.
CONCLUSIONS: PET/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.