Journal Article

Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Karunasaagarar, Kavitasagary, Rintoul, Robert Campbell, Kankam, Osei, Vale, Luke, Hill, James, Madden, Jackie, Cook, Andrew, Miles, Kenneth A, Shah, Andrew, Crosbie, Phil A, Sinclair, Donald, Cozens, Kelly, Tzelis, Dimitrios, Little, Louisa, Groves, Ashley M, Gleeson, Fergus Vincent, McClement, Chris, Dizdarevic, Sabina, Callister, Matthew E J, Poon, Fat-Wui, Jones, Jeremy, Eaton, Rosemary, Peebles, Charles, Brindle, Lucy, Han, Sai, Pike, Lucy, Clegg, Andrew, Harris, Scott, Frew, Anthony, Banerjee, Anindo, Kurban, Lutfi, Weir-McCall, Jonathan R, Moate, Patricia, Gilbert, Fiona J, Qureshi, Nagmi R, Eichhorst, Kathrin, Benedetto, Valerio, George, Steve

2022

Overview

IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration number NCT02013063

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
• Subject: Accuracy / Biopsy / Cost analysis / Cost-Benefit Analysis / Female / Fluorodeoxyglucose F18 / Humans / imaging/CT MRI etc / Lung cancer / Lung Neoplasms - diagnostic imaging / Male / Medical imaging / Medical screening / Metastasis / Patients / Positron Emission Tomography Computed Tomography - methods / Positron-Emission Tomography - methods / Prospective Studies / Radiopharmaceuticals / Sensitivity and Specificity / Solitary Pulmonary Nodule - diagnostic imaging / Tomography / Tomography, X-Ray Computed - methods / Tumors