Authors' objectives:

The objective of this report is to assess, in light of the existing scientific evidence, the relative contribution of Positron Emission Tomography - Computed Tomography (PET-CT) to the clinical management of oncologic patients. This report aims to assess whether this technology is able to provide a higher diagnostic accuracy compared to other available technologies, if it influences the patients' therapeutic management and, finally, if its use can further benefit them.

Authors' results and conclusions: 209 articles met the screening criteria, but only 16 were finally selected (293 patients, 33% of the total number) and 6 were included in the meta-analysis. These 16 articles (12 prospective and 4 retrospective) were classified according to their methodological quality and recommendation in classes B (10 articles) and C (6 articles). A hybrid tomograph PET-CT was used in 11 studies while software-based registration in the other 5. Excluding an article that caused heterogeneity, the sensitivity (Se) was 0,87 (CI 95%, 0,80-0,92), specificity (Sp) 0,89 (CI 95%, 0,82-0,94), Odds Ratio (OR) 41,45 (CI 95%, 12,61-136,27), positive likelihood ratio 6,152 and negative likelihood ratio 0,171 (all these figures are pooled values). Subgroup analysis of the 3 articles of PET-CT in neoplasm staging of non-small cell lung cancer (NSCLC): the pooled values of Se was 0,85 (CI 95%, 0,74-0,92), Sp 0,84 (0,70-0,93) and OR 17,77 (1,32-36,86). And for tumoral restaging, the pooled scores of Se was 0,89 (CI 95%, 0,84-0,94), Sp 0,87 (0,78-0,93) and OR 16,22 (1,11-31,33). Summary point estimates for the same 5 studies presented a Se of 0,89 (0,84-0,94) and a Sp of 0,86 (0,77-0,92) and for neoplasm staging of NSCLC, Se was 0,85 (0,74-0,92) and Sp 0,84 (0,70-0,93). Meta-regression analysis for the 5 studies of re-staging: there was a significant association with co-variables like publication year and number of patients, and a relative association with lnORaji variance and methodology quality. The area under the SROC curve was 0,94 (SE=0,0166) and the Inouye-Sox point estimate (Q*) was 0,88 (SE=0,021), meaning an great discriminatory power for this technology.

Authors' recommendations: PET-CT is an useful diagnostic technique for malignancy detection, with a significant reduction of non-conclusive lesions. Other indications are radiotherapy planning, guide for biopsy and therapy assessment. Diagnostic accuracy of PET-CT for tumoral re-staging (loco-regional & distant metastasis) is a little better than for neoplasm staging. PET-CT could be cost-effective because of the reduction of unnecessary diagnostic methods and surgical or other types of non effective treatments. Some advantages of PET-CT are less time consuming compared with PET alone, more efficiency PET centres and that simultaneous adquisition of PET and CT images limit the alignment problems and changes of patients position. There are still some technological and economic questions without answer, like clinical indications of the test that could be established more accurately when comparative studies of PET-CT and other imaging methods are made. It would be convenient to achive cost-effectiveness and cost-utility studies.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.isciii.es/aets

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias (AETS)