Role of C11-FDG dual-tracer PET-CT scan in metastatic screening of hepatocellular carcinoma—a cost-effectiveness analysis
| Autor: | Tan To Cheung, Wing Chiu Dai, Chung Mau Lo, Ka Wing Ma, Wong Hoi She, Kenneth S. H. Chok, Kevin K. W. Chu, Albert C. Y. Chan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
PET-CT Multivariate analysis medicine.diagnostic_test business.industry Magnetic resonance imaging medicine.disease Confidence interval Metastasis 03 medical and health sciences 0302 clinical medicine Positron emission tomography 030220 oncology & carcinogenesis Relative risk Hepatocellular carcinoma Medicine Original Article 030211 gastroenterology & hepatology Radiology business |
| Zdroj: | Hepatobiliary Surg Nutr |
| ISSN: | 2304-389X 2304-3881 |
| DOI: | 10.21037/hbsn.2019.11.09 |
| Popis: | Background: We aimed to identify predictive factors for positron emission tomography (PET)-detected hepatocellular carcinoma (HCC) metastasis and a cost-effective approach to preoperative PET-computed tomography (CT) for detecting metastasis. Methods: Clinicopathological and survival data of HCC patients having PET-CT with 18F-fludeoxyglucose (FDG) and 11C-acetate (ACT) following contrast-enhanced CT/magnetic resonance imaging (MRI) for preoperative tumor staging were reviewed. Binary logistic regression was performed to identify predictive factors for PET-detected metastasis. A cost-benefit analysis model was built for the incurred costs and the impact of PET-CT findings on treatment strategy was studied. Results: Totally 152 patients were analyzed. Dual-tracer PET-CT detected metastasis in 17 patients (11%). By multivariate analysis, alpha-fetoprotein (AFP) ≥400 ng/mL [relative risk (RR): 4.30, 95% confidence interval (CI): 1.41–13.15, P=0.011] and bilobar disease (RR: 3.94, 95% CI: 1.24–12.52, P=0.014) were independent predictive factors for PET-detected metastasis. PET-CT findings altered the treatment strategy for 12 patients (7.9%); three partial hepatectomies, eight episodes of transarterial chemoembolization (TACE) and one episode of ablation were avoided, with an estimated cost-saving of US $91,000, $150,000 and $10,600 respectively. Had the PET-CT been performed only for patients with AFP ≥400 ng/mL or bilobar disease (n=74), metastasis would have been confirmed in 14 patients (18.9%), and the cost-saving per patient was estimated at US $1,070. Conclusions: Dual-tracer PET-CT is cost-effective and useful for preoperative HCC staging in patients with AFP ≥400 ng/mL or bilobar disease. Its routine use in preoperative workup for all HCC patients is not recommended. Unilobar disease with AFP |
| Databáze: | OpenAIRE |
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