Chest CT and Whole-Body¹⁸F-FDG PET Are Cost-Effective in Screening for Distant Metastases in Head and Neck Cancer Patients

Abstract

The aim of the study was to define the cost-effectiveness of whole-body 18 F-FDG PET, as compared with chest CT, in screening for distant metastases in patients with head and neck squamous cell carcinoma (HNSCC). Methods: In a multicenter prospective study, 145 consecutive patients with high risk factors for distant metastases and scheduled for extensive treatment underwent chest CT and whole-body 18 F-FDG PET for screening of distant metastases. The cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 mo were analyzed. Cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of 18 F-FDG PET, CT, and a combination of CT and 18 F-FDG PET (CT 1 18 F-FDG PET). Results: Pretreatment screening identified distant metastases in 21% of patients. 18 F-FDG PET had a higher sensitivity (53% vs. 37%) and positive predictive value (80% vs. 75%) than did CT. CT 1 18 F-FDG PET had the highest sensitivity (63%). The average costs in the CT, 18 F-FDG PET, and CT 1 18 F-FDG PET groups amounted to e38,558 ($57,705), e38,355 ($57,402), and e37,954 ($56,801), respectively, in the first year after screening. CT 1 18 F-FDG PET resulted in savings between e203 ($303) and e604 ($903). Sensitivity analysis showed that the dominance of CT 1 18 F-FDG PET was robust. Conclusion: In HNSCC patients with risk factors, pretreatment screening for distant metastases by chest CT is improved by 18 F-FDG PET. The combination of 18 F-FDG PET with CT is the most effective, without leading to additional costs.

Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

“…Time-of-flight technology puts additional requirements on the performance of scintillating materials. Thus, LaBr, LYSO and LSO [33] are the materials currently considered for a time-of-flight PET systems. Considering that modern machines provide higher sensitivity and spatial resolution, we may have underestimated the real impact of PET/CT in our population.…”

Cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography in tumours other than lung cancer: A systematic review

“…Thirty-three articles were selected and retrieved in fulltext version (Figure 1). One study was found screening the references [6] and 18 articles were subsequently excluded [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Finally, 16 studies were included [6,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] .…”

The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma

“…Therefore, the indication for metabolic imaging should be handled reluctantly. A recent study showed 18 F-FDG PET/CT is the most eVective pretreatment screening method for distant metastases in HNSCC patients with risk factors [19]. It is our opinion, that in future, when integrated 18 F-FDG PET/CT and MRI scanners become routine, this will be the most cost-eVective imaging method for SNMM.…”