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PET-PANC: Multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-dglucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

PET-PANC: Multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-dglucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer
PET-PANC: Multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-dglucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

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.

1366-5278
Ghaneh, Paula
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Zealley, Ian
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Sarker, Debashis
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Lobo, Dileep
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Nicolson, Marianne
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Halloran, Christopher
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Raraty, Michael
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Sutton, Robert
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Vinjamuri, Sobhan
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Evans, Jonathan
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Deeks, Jon
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Lancaster, Gill
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Plumpton, Catrin
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Yeo, Seow Tien
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Pereira, Stephen P.
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Zealley, Ian
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Sarker, Debashis
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Charnley, Richard
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Lobo, Dileep
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Sutton, Robert
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Vinjamuri, Sobhan
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Evans, Jonathan
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Campbell, Fiona
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Deeks, Jon
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Sanghera, Bal
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Wong, Wai Lup
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Ghaneh, Paula, Hanson, Robert, Titman, Andrew, Lancaster, Gill, Plumpton, Catrin, Lloyd-Williams, Huw, Yeo, Seow Tien, Edwards, Rhiannon Tudor, Johnson, Colin, Hilal, Mohammed Abu, Higginson, Antony P., Armstrong, Tom, Smith, Andrew, Scarsbrook, Andrew, McKay, Colin, Carter, Ross, Sutcliffe, Robert P., Bramhall, Simon, Kocher, Hemant M., Cunningham, David, Pereira, Stephen P., Davidson, Brian, Chang, David, Khan, Saboor, Zealley, Ian, Sarker, Debashis, Sarireh, Bilal Al, Charnley, Richard, Lobo, Dileep, Nicolson, Marianne, Halloran, Christopher, Raraty, Michael, Sutton, Robert, Vinjamuri, Sobhan, Evans, Jonathan, Campbell, Fiona, Deeks, Jon, Sanghera, Bal, Wong, Wai Lup and Neoptolemos, John P. (2018) PET-PANC: Multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-dglucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. Health Technology Assessment, 22 (7). (doi:10.3310/hta22070).

Record type: Article

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.

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e-pub ahead of print date: 1 February 2018
Published date: 1 February 2018

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Local EPrints ID: 420400
URI: https://eprints.soton.ac.uk/id/eprint/420400
ISSN: 1366-5278
PURE UUID: 47a96a20-de71-4651-bbd7-7cbfce566536

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Date deposited: 04 May 2018 16:31
Last modified: 10 Jan 2019 17:30

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Contributors

Author: Paula Ghaneh
Author: Robert Hanson
Author: Andrew Titman
Author: Gill Lancaster
Author: Catrin Plumpton
Author: Huw Lloyd-Williams
Author: Seow Tien Yeo
Author: Rhiannon Tudor Edwards
Author: Colin Johnson
Author: Mohammed Abu Hilal
Author: Antony P. Higginson
Author: Tom Armstrong
Author: Andrew Smith
Author: Andrew Scarsbrook
Author: Colin McKay
Author: Ross Carter
Author: Robert P. Sutcliffe
Author: Simon Bramhall
Author: Hemant M. Kocher
Author: David Cunningham
Author: Stephen P. Pereira
Author: Brian Davidson
Author: David Chang
Author: Saboor Khan
Author: Ian Zealley
Author: Debashis Sarker
Author: Bilal Al Sarireh
Author: Richard Charnley
Author: Dileep Lobo
Author: Marianne Nicolson
Author: Christopher Halloran
Author: Michael Raraty
Author: Robert Sutton
Author: Sobhan Vinjamuri
Author: Jonathan Evans
Author: Fiona Campbell
Author: Jon Deeks
Author: Bal Sanghera
Author: Wai Lup Wong
Author: John P. Neoptolemos

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