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J Nucl Med. 2008; 49 (Supplement 1):40P
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General Clinical Specialties: Operations/Practice Based/Outcomes Research

Siemens Award for Excellence in Practice Based Research

Diagnostic effectiveness, cost-effectiveness and prognostic utility of PET/CT in non-small cell lung cancer (NSCLC)

Andreas Buck1, Ken Herrmann1, Jonas Schreyogg3, Gerhard Glatting2, Klemens Scheidhauer1, Stefan Schmidt1, Hasema Lesevic2, Markus Schwaiger1 and Sven Reske2

1 Nuclear Medicine, TU Munich, Munich, Germany; 2 Nuclear Medicine, University Ulm, Ulm, Germany; 3 Health Care Management, TU Berlin, Berlin, Germany

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Objectives: The aim of this prospective bi-center trial was to evaluate the diagnostic accuracy, prognostic potential and cost effectiveness of PET/CT for staging NSCLC.

Methods: Between 4/03 - 12/06, 205 patients with proven NSCLC were recruited. 60-90 min after injection of FDG, CE-CT was performed followed by PET using integrated PET/CT scanners. CT, PET and PET/CT were interpreted separately for evaluation of tumor stage according to TNM and UICC. Histology served as reference in 87 pts undergoing resective surgery. 118 pts received palliative treatment. To date, median follow-up is 455 days. Costs were estimated based on data obtained from hospital admistrative departments.

Results: PET/CT provided significantly higher diagnostic accuracy for T- and N-staging compared to CT and PET (p<0.0001). The addition of PET/CT to the diagnostic work-up resulted in 13 additional surgical procedures (down-staging in 18 pts) and cancellation of 9 (upstaging in 12 pts). Pts with tumor stage UICC I-IIIa<N2 at PET/CT undergoing surgery had a favourable outcome with median survival not reached (68% long-term survivors), in pts staged UICC IIIb-IV, median survival was 318 days (p<0.0001, hazard ratio 0.32). Median survival in UICC I-IIIa<N2 vs. UICC IIIb-IV, as staged with CT, was 1022 and 499 d (PET: 1036 and 312 d).

Conclusions: PET/CT offered the highest diagnostic accuracy for staging NSCLC and resulted in a change of management in 12.4%. PET/CT is a strong predictor of survival indicating those patients with favourable outcome after curative surgery. PET/CT is cost effective due to reduction of the number of curative operations performed in patients with advanced disease.





This Article
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Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Buck, A.
Right arrow Articles by Reske, S.
PubMed
Right arrow Articles by Buck, A.
Right arrow Articles by Reske, S.