Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Gilbert, F. J. et al. (2022) Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules. Thorax, 77(10), pp. 988-996. (doi: 10.1136/thoraxjnl-2021-216948) (PMID:34887348)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Han, Dr Sai
Authors: Gilbert, F. J., Harris, S., Miles, K. A., Weir-McCall, J. R., Qureshi, N. R., Rintoul, R. C., Dizdarevic, S., Pike, L., Sinclair, D., Shah, A., Eaton, R., Jones, J., Clegg, A., Benedetto, V., Hill, J., Cook, A., Tzelis, D., Vale, L., Brindle, L., Madden, J., Cozens, K., Little, L., Eichhorst, K., Moate, P., McClement, C., Peebles, C., Banerjee, A., Han, S., Poon, F.-W., Groves, A. M., Kurban, L., Frew, A., Callister, M. E.J., Crosbie, P. A., Gleeson, F. V., Karunasaagarar, K., Kankam, O., and George, S.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Journal Name:Thorax
Publisher:BMJ Publishing Group
ISSN (Online):1468-3296
Published Online:09 December 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Thorax 77(10): 988-996
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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