TY - JOUR
T1 - Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules
AU - Gilbert, Fiona J
AU - Harris, Scott
AU - Miles, Kenneth A
AU - Weir-McCall, Jonathan R
AU - Qureshi, Nagmi R
AU - Rintoul, Robert Campbell
AU - Dizdarevic, Sabina
AU - Pike, Lucy
AU - Sinclair, Donald
AU - Shah, Andrew
AU - Eaton, Rosemary
AU - Jones, Jeremy
AU - Clegg, Andrew
AU - Benedetto, Valerio
AU - Hill, James
AU - Cook, Andrew
AU - Tzelis, Dimitrios
AU - Vale, Luke
AU - Brindle, Lucy
AU - Madden, Jackie
AU - Cozens, Kelly
AU - Little, Louisa
AU - Eichhorst, Kathrin
AU - Moate, Patricia
AU - McClement, Chris
AU - Peebles, Charles
AU - Banerjee, Anindo
AU - Han, Sai
AU - Poon, Fat-Wui
AU - Groves, Ashley M
AU - Kurban, Lutfi
AU - Frew, Anthony
AU - Callister, Matthew E J
AU - Crosbie, Phil A
AU - Gleeson, Fergus Vincent
AU - Karunasaagarar, Kavitasagary
AU - Kankam, Osei
AU - George, Steve
N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/12/9
Y1 - 2021/12/9
N2 - Introduction Dynamic 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.
Methods In 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.
Results 312 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
AB - Introduction Dynamic 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.
Methods In 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.
Results 312 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
U2 - 10.1136/thoraxjnl-2021-216948
DO - 10.1136/thoraxjnl-2021-216948
M3 - Article
C2 - 34887348
SN - 0040-6376
SP - thoraxjnl-2021-216948
JO - Thorax
JF - Thorax
ER -