Abstract:BACKGROUND: A possible surveillance model for patients with head and neck cancer (HNC) who received definitive radiotherapy was created using a partially observed Markov decision process. The goal of this model is to guide surveillance imaging policies after definitive radiotherapy. METHODS: The partially observed Markov decision process model was formulated to determine the optimal times to scan patients. Transition probabilities were computed using a data set of 1508 patients with HNC who received definitive… Show more
“…In particular, current NCCN guidelines recommend ND if a positive PET/CT scan is associated with a lymph node dimension greater than 1 cm at the morphologic imaging 2 . In all cases with discordant imaging results, the decision to observe a watchful waiting or a surgical approach should be customized to the patient 16 . In this context, fine‐needle aspiration cytology (FNAC) of suspicious nodes represents a complementary tool.…”
Purpose
To define the accuracy of fine‐needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients.
Methods
The study was performed according to the PRISMA‐DTA guidelines.
Results
A total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%‐80.7%; I2 = 79.5%) and 84.2% (95% CI: 71.8%‐93.5%; I2 = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89‐38.99; I2 = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3‐11.2) and 0.37 (95% CI: 0.22‐0.54), respectively.
Conclusions
FNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.
“…In particular, current NCCN guidelines recommend ND if a positive PET/CT scan is associated with a lymph node dimension greater than 1 cm at the morphologic imaging 2 . In all cases with discordant imaging results, the decision to observe a watchful waiting or a surgical approach should be customized to the patient 16 . In this context, fine‐needle aspiration cytology (FNAC) of suspicious nodes represents a complementary tool.…”
Purpose
To define the accuracy of fine‐needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients.
Methods
The study was performed according to the PRISMA‐DTA guidelines.
Results
A total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%‐80.7%; I2 = 79.5%) and 84.2% (95% CI: 71.8%‐93.5%; I2 = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89‐38.99; I2 = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3‐11.2) and 0.37 (95% CI: 0.22‐0.54), respectively.
Conclusions
FNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.
“…This finding corroborates previous studies which suggested PET/CT surveillance's cost-effectiveness for all HNC patients without stratification by HPV status. 19,26 PET/CT, with a reported NPV of 91% to 98%, [27][28][29] with clinical surveillance has been suggested as a clinically effective approach in detecting tumor recurrence among HPV +OPSCC patients 27 ; however, no comment was made on this approach's cost-effectiveness. Our decision to perform imaging surveillance at 1 year in our model is also consistent with studies that found PET/CT's predictive ability to be optimal between 3 months and 2 years.…”
ObjectiveTo determine the cost‐effectiveness of surveillance imaging with PET/CT scan among patients with human papillomavirus‐positive oropharyngeal squamous cell carcinoma.Study DesignCost‐effectiveness analysis.SettingOncologic care centers in the United States with head and neck oncologic surgeons and physicians.MethodsWe compared the cost‐effectiveness of 2 posttreatment surveillance strategies: clinical surveillance with the addition of PET/CT scan versus clinical surveillance alone in human papillomavirus‐positive oropharyngeal squamous cell carcinoma patients. We constructed a Markov decision model which was analyzed from a third‐party payer's perspective using 1‐year Markov cycles and a 30‐year time horizon. Values for transition probabilities, costs, health care utilities, and their studied ranges were derived from the literature.ResultsThe incremental cost‐effectiveness ratio for PET/CT with clinical surveillance versus clinical surveillance alone was $89,850 per quality‐adjusted life year gained. Flexible fiberoptic scope exams during clinical surveillance would have to be over 51% sensitive or PET/CT scan cost would have to exceed $1678 for clinical surveillance alone to be more cost‐effective. The willingness‐to‐pay threshold at which imaging surveillance was equally cost‐effective to clinical surveillance was approximately $80,000/QALY.ConclusionDespite lower recurrence rates of human papillomavirus‐positive oropharyngeal cancer, a single PET/CT scan within 6 months after primary treatment remains a cost‐effective tool for routine surveillance when its cost does not exceed $1678. The cost‐effectiveness of this strategy is also dependent on the clinical surveillance sensitivity (flexible fiberoptic pharyngoscopy), and willingness‐to‐pay thresholds which vary by country.
“…Our study is similar to the work by Ng et al, who developed a Markov model for HNC that was used for surveillance optimization. The same group found that imaging beyond 2 years after treatment was low yield and high cost .…”
Section: Discussionmentioning
confidence: 99%
“… 18 , 19 , 20 , 21 Markov models have already been used to simulate cancer recurrence. 22 , 23 , 24 , 25 , 26 , 27 , 28 However, many models lack disease-specific risk stratification.…”
Section: Introductionmentioning
confidence: 99%
“…They can capture the specific incidence and prognosis of local vs metastatic recurrence as well as false-positive and false-negative rates for different imaging studies . Markov models have already been used to simulate cancer recurrence . However, many models lack disease-specific risk stratification.…”
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