F-18 NaF PET for Detection of Bone Metastases in Lung Cancer: Accuracy, Cost-Effectiveness, and Impact on Patient Management
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- Martin Hetzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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- Coskun Arslandemir
- Department of Nuclear Medicine, University of Ulm, Ulm, Germany
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- Hans-Helmut König
- Health Economics Research Unit, University of Leipzig, Leipzig, Germany
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- Andreas K Buck
- Department of Nuclear Medicine, University of Ulm, Ulm, Germany
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- Karin Nüssle
- Department of Diagnostic Radiology, University of Ulm, Ulm, Germany
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- Gerhard Glatting
- Department of Nuclear Medicine, University of Ulm, Ulm, Germany
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- Andreas Gabelmann
- Department of Diagnostic Radiology, University of Ulm, Ulm, Germany
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- JÜRgen Hetzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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- Vinzenz Hombach
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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- Holger Schirrmeister
- Department of Nuclear Medicine, University of Ulm, Ulm, Germany
Abstract
<jats:title>Abstract</jats:title> <jats:p>As bone metastases might be present in lung cancer despite a normal bone scan, we examined various alternatives prospectively. Positron emission tomography using F-18 sodium fluoride (PET) and single photon emission tomography (SPECT) were more sensitive than a planar bone scan. PET was more accurate with a shorter examination time than SPECT but had higher incremental costs.</jats:p> <jats:p>Introduction: Previous studies have shown that vertebral bone metastases not seen on planar bone scans may be present on F-18 fluoride positron emission tomography (PET) scan or single photon emission computed tomography (SPECT). The purpose of this study was to measure the accuracy, clinical value and cost-effectiveness of tomographic bone imaging.</jats:p> <jats:p>Materials and Methods: A total of 103 patients with initial diagnosis of lung cancer was prospectively examined with planar bone scintigraphy (BS), SPECT of the vertebral column and PET using F-18 sodium fluoride (F-18 PET). Receiver operating characteristic (ROC) curve analysis was used for determination of the diagnostic accuracy. A decision-analysis model and the national charge schedule of the German Hospital Association were used for determination of the cost-effectiveness.</jats:p> <jats:p>Results: Thirteen of 33 patients with bone metastases were false negative on BS, 4 on SPECT, and 2 on F-18 PET. The area under the ROC curve was 0.771 for BS, 0.875 for SPECT, and 0.989 for F-18 PET (p < 0.05). As a result of SPECT and F-18 PET imaging, clinical management was changed in 8 (7.8%) and 10 (9.7%) patients. Compared with BS, the costs per additional correctly diagnosed patient were 1272 Euro with SPECT and 2861 Euro with F-18 PET. The threshold for the costs of F-18 PET being more cost-effective than SPECT was 345 EUR.</jats:p> <jats:p>Conclusion: Routine performance of tomographic bone imaging improves the therapeutic strategy because of detection of otherwise missed metastases. F-18 PET is more effective than SPECT but is associated with higher incremental costs.</jats:p>
Journal
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- Journal of Bone and Mineral Research
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Journal of Bone and Mineral Research 18 (12), 2206-2214, 2003-12-01
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1362825894455855872
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- NII Article ID
- 30021657478
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- ISSN
- 15234681
- 08840431
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- Data Source
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- Crossref
- CiNii Articles