PET-PANC: Multi-centre trial of 18Fluorine-2-fluoro-2-deoxy-D-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer.


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Paula Ghaneh1,Wai-Lup Wong2,Sobhan Vinjamuri3,Colin Johnson4,Mohamed Abu Hilal5,Antony Higginson6,Andrew Smith7,Andrew Scarsbrook8,Colin Mckay9,Robert Sutcliffe10,Hemant Kocher11,David Cunningham12,Stephen Pereira13,Brian Davidson14,David Chang15,Saboor Khan16,Bal Sanghera17,Andrew Titman18,Gillian Lancaster19,Catrin Plumpton20,Seow Tien Yeo21,Robert Hanson22,Christopher Halloran23,John Neoptolemos23
1University of Liverpool,2Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK,3Royal Liverpool and Broadgreen University Hospitals NHS Trust,4Faculty of Medicine, University of Southampton, Southampton, UK.,5Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,6Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,7Department of Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,8Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,9Department of Surgery, Glasgow Royal Infirmary - NHS Greater Glasgow and Clyde, Glasgow, UK.,10Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,11Barts Cancer Institute, Barts and the London, London, UK.,12Gastrointestinal and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,13Institute for Liver and Digestive Health, University College London Hospitals NHS Foundation Trust, London, UK.,14Department of Surgery, Royal Free London NHS Foundation Trust, London, UK.,15Department of Surgery, Royal Blackburn Hospital- East Lancashire Hospitals NHS Trust, Blackburn,UK.,16Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,17Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.,18Department of Mathematics and Statsistics, Lancaster University, Lancaster, UK,19Department of Mathematics and Statsistics, Lancaster University, Lancaster, UK.,20Centre for Health Economics and Medicines Evaluation, Bangor University, Lancaster, UK.,21Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.,22Liverpool Cancer Research UK Cancer Trials Unit, University of Liverpool, Liverpool, UK,23Department Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.

Abstract

Background

Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. The use of 18Fluorine-2-fluoro-2-deoxy-D-glucose positron emission tomography with computed tomography scanning (PET/CT) may add further value to the diagnosis and staging of pancreatic cancer. The aim of this study was to determine the clinical impact of PET/CT in addition to standard diagnostic workup in patients with suspected pancreatic cancer.

Method

Eligible patients with suspected pancreatic cancer underwent PET/CT following multi-detector CT (MDCT). Diagnosis and management decisions were recorded before and after PET/CT. Reference standard diagnosis was based on histology or clinical outcome at 12 months. Primary outcome measure was incremental diagnostic value of PET/CT in addition to MDCT. Secondary outcome measures were changes in diagnosis, staging, and management; cost effectiveness was estimated. 

Results

A total of 18 UK centres, between 2011 and 2013, recruited 550 patients with complete data and in range PET/CT. 261 patients (47%) had pancreatic cancer. The sensitivity and specificity for the diagnosis of pancreatic cancer for MDCT was 88.5%, 70.6% and for PET/CT was 92.7%, 75.8% respectively. PET/CT demonstrated significant improvement in relative sensitivity (p=0.01) and specificity (p=0.023) compared to MDCT. PET/CT correctly changed the staging of PDAC in 56 patients (14%) (p=0.001). PET/CT influenced management in 250 (45%) of patients and stopped resection in 58 patients (20%) 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 QALY gain of 0.0157 (95% CI -0.0101, 0.0430). In the base case model PET/CT was seen to dominate MDCT alone and is likely to be cost effective.

Conclusion

PET/CT provided significant additional benefit in the diagnosis, staging and management of pancreatic cancer. PET/CT was cost effective at current reimbursement rates to the UK NHS.

*This project was funded by the NIHR HTA (project number 08/29/02).

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