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.
Session type: Oral
Theme: Diagnosis and therapy
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.
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.
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.
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).