Authors' recommendations: Positron emission tomography-computerised axial tomography (PET-CT) appears to provide improved diagnostic capabilities when compared to positron emission tomography (PET) or computerised axial tomography (CT) alone, depending on the type of tumour, the stage of tumour and whether analysed on a lesion-by-lesion basis or by patient. The highest level of available evidence (1b) suggests that PET-CT is significantly more accurate at determining non-small cell lung carcinoma tumour and node staging than PET alone. Further low level evidence indicates that PET-CT improves the localisation of lesions by 19 to 66 per cent and decreases the number of equivocal lesions by approximately 30 per cent, when compared to PET alone. Low quality abstract studies reported that PET-CT changed the clinical management of patients in one study when compared PET alone, in four studies when compared to CT alone and in three studies when compared to the gold standard of diagnostic work-up. Changes in clinical management include patients receiving chemotherapy instead of surgery, receiving salvage chemotherapy instead of observation, receiving increased radiation therapy and receiving observation rather than chemotherapy or surgery after returning negative PET-CT results. However, there is currently no available evidence to indicate the effect on patient health resulting from these changes in clinical management. Level 1b evidence also indicates significant improvements in non-small cell lung carcinoma tumour staging with PET-CT, although not in nodal staging, compared to CT alone. Lower level evidence reports improvements in the identification of the number of lesions with PET-CT, ranging from 45-80%, and changes in clinical management in 35-73% of patients, compared to CT alone. The specificity for PET-CT when compared to the gold standard of diagnostic and histological work-up, in level 1b evidence, is 67%. In addition, the sensitivity in this study was reported as 86% with an associated false positive rate of 14%, which indicates a substantial proportion of false positive diagnoses of colorectal cancer lesions. A slightly poorer quality study (level 3b) suggests PET-CT can positively predict 96% of epithelial ovarian cancer lesions. Diagnostic accuracy, therefore appears to vary according to the tumour type and staging of the disease. Data on the safety of PET-CT is very limited. It is likely that radiation doses delivered to patients are reduced if patients undergo a combined PET-CT scan, compared to undergoing separate PET and CT scans. Currently, access to PET-CT is limited to a few hospitals in capital cities in Australia. The capital cost of purchasing a PET-CT scanner is estimated to be $2-5 million AUD, which would limit its introduction to all but major hospitals. If PET-CT was utilised for all patients with newly diagnosed cancers of all types for at least one scan, the estimated costs to the health system would be $81 million per year.

Project Status: Completed

Year Published: 2004

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)