Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules. Issue 10 (9th December 2021)

• Record Type: Journal Article
• Authors: 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;
• Is Part Of: Thorax. Volume 77:Issue 10(2022)
• Page Start: 988
• Page End: 996
• Publication Date: 2021-12-09
• Subjects: lung cancer -- imaging/CT MRI etc; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2021-216948
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Dynamic 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. 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