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dc.contributor.authorGhaneh, Pen_US
dc.contributor.authorHanson, Ren_US
dc.contributor.authorTitman, Aen_US
dc.contributor.authorLancaster, Gen_US
dc.contributor.authorPlumpton, Cen_US
dc.contributor.authorLloyd-Williams, Hen_US
dc.contributor.authorYeo, STen_US
dc.contributor.authorEdwards, RTen_US
dc.contributor.authorJohnson, Cen_US
dc.contributor.authorAbu Hilal, Men_US
dc.contributor.authorHigginson, APen_US
dc.contributor.authorArmstrong, Ten_US
dc.contributor.authorSmith, Aen_US
dc.contributor.authorScarsbrook, Aen_US
dc.contributor.authorMcKay, Cen_US
dc.contributor.authorCarter, Ren_US
dc.contributor.authorSutcliffe, RPen_US
dc.contributor.authorBramhall, Sen_US
dc.contributor.authorKocher, HMen_US
dc.contributor.authorCunningham, Den_US
dc.contributor.authorPereira, SPen_US
dc.contributor.authorDavidson, Ben_US
dc.contributor.authorChang, Den_US
dc.contributor.authorKhan, Sen_US
dc.contributor.authorZealley, Ien_US
dc.contributor.authorSarker, Den_US
dc.contributor.authorAl Sarireh, Ben_US
dc.contributor.authorCharnley, Ren_US
dc.contributor.authorLobo, Den_US
dc.contributor.authorNicolson, Men_US
dc.contributor.authorHalloran, Cen_US
dc.contributor.authorRaraty, Men_US
dc.contributor.authorSutton, Ren_US
dc.contributor.authorVinjamuri, Sen_US
dc.contributor.authorEvans, Jen_US
dc.contributor.authorCampbell, Fen_US
dc.contributor.authorDeeks, Jen_US
dc.contributor.authorSanghera, Ben_US
dc.contributor.authorWong, W-Len_US
dc.contributor.authorNeoptolemos, JPen_US
dc.date.accessioned2019-04-17T08:50:28Z
dc.date.issued2018-02
dc.identifier.citationHealth technology assessment (Winchester, England), 2018, 22 (7), pp. 1 - 114
dc.identifier.issn1366-5278
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/3185
dc.identifier.eissn2046-4924
dc.identifier.doi10.3310/hta22070
dc.description.abstractBackground Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUV max. ) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity ( p  = 0.01) and specificity ( p  = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios ( p  < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients ( p  = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were 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 gain in quality-adjusted life-years of 0.0157 (95% confidence interval -0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.
dc.formatPrint
dc.format.extent1 - 114
dc.languageeng
dc.language.isoeng
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.subjectHumans
dc.subjectCarcinoma, Pancreatic Ductal
dc.subjectPancreatic Neoplasms
dc.subjectFluorodeoxyglucose F18
dc.subjectNeoplasm Staging
dc.subjectModels, Econometric
dc.subjectSensitivity and Specificity
dc.subjectProspective Studies
dc.subjectQuality-Adjusted Life Years
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectCost-Benefit Analysis
dc.subjectState Medicine
dc.subjectFemale
dc.subjectMale
dc.subjectPancreatitis, Chronic
dc.subjectYoung Adult
dc.subjectMultidetector Computed Tomography
dc.subjectUnited Kingdom
dc.subjectPositron Emission Tomography Computed Tomography
dc.titlePET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer.
dc.typeOther
rioxxterms.versionofrecord10.3310/hta22070
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
rioxxterms.licenseref.startdate2018-02
rioxxterms.typeOther
dc.relation.isPartOfHealth technology assessment (Winchester, England)
pubs.issue7
pubs.notesNo embargo
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.)
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume22
pubs.embargo.termsNo embargo
icr.researchteamMedicine (RMH Smith Cunningham)en_US
dc.contributor.icrauthorCunningham, Daviden


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