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Whole body 18F-FDG PET/CT is superior to CT as first line diagnostic imaging in patients referred with serious non-specific symptoms or signs of cancer: a randomized prospective study of 200 patients

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@article{64d896cccbd947a78771d1c3b0841fb9,
title = "Whole body 18F-FDG PET/CT is superior to CT as first line diagnostic imaging in patients referred with serious non-specific symptoms or signs of cancer: a randomized prospective study of 200 patients",
abstract = "A fast-track pathway has been established in Denmark to investigate patients with serious non-specific symptoms and signs of cancer (NSSC), which are not eligible to enter an organ-specific cancer program. The prevalence of cancer in this cohort is approximately 20{\%}. The optimal screening strategy in patients with NSSC remains unknown. The aim was to investigate if (18)F-FDG-positron emission tomography/computed tomography (PET/CT) was superior to CT as initial imaging modality in patients with NSSC. In a randomized prospective trial the imaging modalities were compared with regard to diagnostic performance.METHODS: A total of 200 patients were randomized 1:1 to whole body (18)F-FDG-PET/CT or CT of the thorax and abdomen as imaging modality. A tentative diagnosis was established after first line imaging. The final referral diagnosis was adjudicated by the physician, when sufficient data was available.RESULTS: A total of 197 patients were available for analysis as 3 patients withdrew consent prior to scan. Thirty-nine (20{\%}) were diagnosed with cancer, 10 (5{\%}) with an infection, 15 (8{\%}) with an autoimmune disease and 76 (39{\%}) with other diseases. In 57 patients (28{\%}) no specific disease was found. Compared to CT scans, (18)F-FDG-PET/CT had a higher specificity (96 vs. 85{\%}; P = 0.028) and a higher accuracy (94 vs. 82{\%}; P = 0.017). However, there were no statistically significant differences in sensitivity (83 vs. 70{\%}) or negative predictive values (96 vs. 92{\%}). No difference in days to final referral diagnosis according to randomization group could be shown (7.2 vs. 7.6 days). However, for the subgroups where the imaging modality showed suspicion of malignancy, there was a significant delay to final diagnosis in the CT group compared to the (18)F-FDG-PET/CT group (11.6 vs. 5.7 days; P = 0.02).CONCLUSION: We found a higher diagnostic specificity and accuracy of (18)F-FDG-PET/CT compared to CT for detecting cancer in patients with NSSC. (18)F-FDG-PET/CT should therefore be considered as first line imaging in this group of patients.",
author = "Anne-Mette Lebech and Anne Gaardsting and Annika Loft and Jesper Graff and Elena Markova and Berthelsen, {Anne Kiil} and Madsen, {Jan Lysgaard} and Morten Helms and Mathiesen, {Lars R} and David, {Kim P} and Gitte Kronborg and Andreas Kjaer and Andersen, {Kim Francis} and {von Benzon}, Eric",
note = "Copyright {\circledC} 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.",
year = "2017",
month = "7",
day = "1",
doi = "10.2967/jnumed.116.175380",
language = "English",
volume = "58",
pages = "1058--1064",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine",
number = "7",

}

RIS

TY - JOUR

T1 - Whole body 18F-FDG PET/CT is superior to CT as first line diagnostic imaging in patients referred with serious non-specific symptoms or signs of cancer

T2 - a randomized prospective study of 200 patients

AU - Lebech, Anne-Mette

AU - Gaardsting, Anne

AU - Loft, Annika

AU - Graff, Jesper

AU - Markova, Elena

AU - Berthelsen, Anne Kiil

AU - Madsen, Jan Lysgaard

AU - Helms, Morten

AU - Mathiesen, Lars R

AU - David, Kim P

AU - Kronborg, Gitte

AU - Kjaer, Andreas

AU - Andersen, Kim Francis

AU - von Benzon, Eric

N1 - Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - A fast-track pathway has been established in Denmark to investigate patients with serious non-specific symptoms and signs of cancer (NSSC), which are not eligible to enter an organ-specific cancer program. The prevalence of cancer in this cohort is approximately 20%. The optimal screening strategy in patients with NSSC remains unknown. The aim was to investigate if (18)F-FDG-positron emission tomography/computed tomography (PET/CT) was superior to CT as initial imaging modality in patients with NSSC. In a randomized prospective trial the imaging modalities were compared with regard to diagnostic performance.METHODS: A total of 200 patients were randomized 1:1 to whole body (18)F-FDG-PET/CT or CT of the thorax and abdomen as imaging modality. A tentative diagnosis was established after first line imaging. The final referral diagnosis was adjudicated by the physician, when sufficient data was available.RESULTS: A total of 197 patients were available for analysis as 3 patients withdrew consent prior to scan. Thirty-nine (20%) were diagnosed with cancer, 10 (5%) with an infection, 15 (8%) with an autoimmune disease and 76 (39%) with other diseases. In 57 patients (28%) no specific disease was found. Compared to CT scans, (18)F-FDG-PET/CT had a higher specificity (96 vs. 85%; P = 0.028) and a higher accuracy (94 vs. 82%; P = 0.017). However, there were no statistically significant differences in sensitivity (83 vs. 70%) or negative predictive values (96 vs. 92%). No difference in days to final referral diagnosis according to randomization group could be shown (7.2 vs. 7.6 days). However, for the subgroups where the imaging modality showed suspicion of malignancy, there was a significant delay to final diagnosis in the CT group compared to the (18)F-FDG-PET/CT group (11.6 vs. 5.7 days; P = 0.02).CONCLUSION: We found a higher diagnostic specificity and accuracy of (18)F-FDG-PET/CT compared to CT for detecting cancer in patients with NSSC. (18)F-FDG-PET/CT should therefore be considered as first line imaging in this group of patients.

AB - A fast-track pathway has been established in Denmark to investigate patients with serious non-specific symptoms and signs of cancer (NSSC), which are not eligible to enter an organ-specific cancer program. The prevalence of cancer in this cohort is approximately 20%. The optimal screening strategy in patients with NSSC remains unknown. The aim was to investigate if (18)F-FDG-positron emission tomography/computed tomography (PET/CT) was superior to CT as initial imaging modality in patients with NSSC. In a randomized prospective trial the imaging modalities were compared with regard to diagnostic performance.METHODS: A total of 200 patients were randomized 1:1 to whole body (18)F-FDG-PET/CT or CT of the thorax and abdomen as imaging modality. A tentative diagnosis was established after first line imaging. The final referral diagnosis was adjudicated by the physician, when sufficient data was available.RESULTS: A total of 197 patients were available for analysis as 3 patients withdrew consent prior to scan. Thirty-nine (20%) were diagnosed with cancer, 10 (5%) with an infection, 15 (8%) with an autoimmune disease and 76 (39%) with other diseases. In 57 patients (28%) no specific disease was found. Compared to CT scans, (18)F-FDG-PET/CT had a higher specificity (96 vs. 85%; P = 0.028) and a higher accuracy (94 vs. 82%; P = 0.017). However, there were no statistically significant differences in sensitivity (83 vs. 70%) or negative predictive values (96 vs. 92%). No difference in days to final referral diagnosis according to randomization group could be shown (7.2 vs. 7.6 days). However, for the subgroups where the imaging modality showed suspicion of malignancy, there was a significant delay to final diagnosis in the CT group compared to the (18)F-FDG-PET/CT group (11.6 vs. 5.7 days; P = 0.02).CONCLUSION: We found a higher diagnostic specificity and accuracy of (18)F-FDG-PET/CT compared to CT for detecting cancer in patients with NSSC. (18)F-FDG-PET/CT should therefore be considered as first line imaging in this group of patients.

U2 - 10.2967/jnumed.116.175380

DO - 10.2967/jnumed.116.175380

M3 - Journal article

VL - 58

SP - 1058

EP - 1064

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 7

ER -

ID: 49648099