Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules—the SPUtNIk study

Qureshi, Nagmi R.; Rintoul, Robert C.; Miles, Kenneth A.; George, Steve; Harris, Scott; Madden, J.; Cozens, Kelly; Little, Louisa; Eichhorst, Kathrin; Jones, Jeremy; Moate, Patricia; McClement, Chris; Pike, Lucy; Sinclair, Donald A. R.; Wong, Wai-Hoi; Shekhdar, Jane; Eaton, Rosemary; Shah, Andrew; Brindle, Lucy; Peebles, Charles; Banerjee, A. K.; Dizdarevic, Sabina; Han, Sai; Poon, F. W.; Groves, Ashley M.; Kurban, Lutfi; Frew, Anthony J.; Callister, Matthew; Gleeson, Fergus; Karunasaagarar, Kavitasagary; Kankam, Osei; Gilbert, Fiona J.

doi:10.1136/bmjresp-2016-000156

Cited by 6 publications

(12 citation statements)

References 4 publications

(4 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…A multicentre prospective cohort observational study initiated in 2016 is set to assess the performance and the cost-effectiveness of the dynamic CT and PET/CT in the characterisation of solitary pulmonary nodules. 56 The small sample size limits the assessments of accuracy in our study. However, on this small sample we showed increase diagnostic improvement in the accuracy of diagnosis in both dynamic studies when compared to the conventional 18 F-FDG PET/ CT. Specificity in K i and BV on our small sample size were higher at the estimated threshold values of 0.01 min -1 and 21 ml/100ml, respectively.…”

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confidence: 93%

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Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

Marin

Murchison

Skwarski

et al. 2021

Radiology and Oncology

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Background The aim of the study was to derive and compare metabolic parameters relating to benign and malignant pulmonary nodules using dynamic 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) PET/CT, and nodule perfusion parameters derived through perfusion computed tomography (CT). Patients and methods Twenty patients with 21 pulmonary nodules incidentally detected on CT underwent a dynamic 18F-FDG PET/CT and a perfusion CT. The maximum standardized uptake value (SUVmax) was measured on conventional 18F-FDG PET/CT images. The influx constant (Ki ) was calculated from the dynamic 18F-FDG PET/CT data using Patlak model. Arterial flow (AF) using the maximum slope model and blood volume (BV) using the Patlak plot method for each nodule were calculated from the perfusion CT data. All nodules were characterized as malignant or benign based on histopathology or 2 year follow up CT. All parameters were statistically compared between the two groups using the nonparametric Mann-Whitney test. Results Twelve malignant and 9 benign lung nodules were analysed (median size 20.1 mm, 9–29 mm) in 21 patients (male/female = 11/9; mean age ± SD: 65.3 ± 7.4; age range: 50–76 years). The average SUVmax values ± SD of the benign and malignant nodules were 2.2 ± 1.7 vs. 7.0 ± 4.5, respectively (p = 0.0148). Average Ki values in benign and malignant nodules were 0.0057 ± 0.0071 and 0.0230 ± 0.0155 min-1, respectively (p = 0.0311). Average BV for the benign and malignant nodules were 11.6857 ± 6.7347 and 28.3400 ± 15.9672 ml/100 ml, respectively (p = 0.0250). Average AF for the benign and malignant nodules were 74.4571 ± 89.0321 and 89.200 ± 49.8883 ml/100g/min, respectively (p = 0.1613). Conclusions Dynamic 18F-FDG PET/CT and perfusion CT derived blood volume had similar capability to differentiate benign from malignant lung nodules.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

Marin

Murchison

Skwarski

et al. 2021

Radiology and Oncology

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“…The full trial protocol has been published 10 and registered on Clinical trials.gov (NCT02013063). The SPUtNIk Trial was approved by the South West Research Ethics Committee Centre (12/SW/0206, UK).…”

Section: Methodsmentioning

confidence: 99%

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

Gilbert

Harris

Miles

et al. 2021

Thorax

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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 numberNCT02013063

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“…This prospective multicentre observational study compared the diagnostic accuracy of PET/CT with that of dynamic contrast enhanced CT in a cohort of patients with an indeterminate solitary pulmonary nodule (SPN) (Trial registration: ISRCTN - ISRCTN30784948; ClinicalTrials.gov - NCT02013063). The full trial protocol has been previously published [ 12 ]. The SPUtNIk Trial was approved by the South West Research Ethics Committee Centre (UK).…”

Section: Methodsmentioning

confidence: 99%

Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial

Weir‐McCall

Harris

Miles

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. Methods Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. Results Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. Conclusion In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. Trial registration ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063

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Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules—the SPUtNIk study

Cited by 6 publications

References 4 publications

Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

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

Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial

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Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules—the SPUtNIk study

Cited by 6 publications

References 4 publications

Can dynamic imaging, using 18F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

Can dynamic imaging, using 18F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

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

Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial

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Product

Resources

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Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?

Can dynamic imaging, using ¹⁸F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules?