PET/CT for staging lung cancer: costly or cost-saving?

Excerpt

Integrated functional and anatomical imaging using positron emission tomography (PET)/CT hybrid scanners has changed the diagnostic algorithm in non-small cell lung cancer (NSCLC). The accuracy for detection of lymph node and distant organ metastases is superior to separately performed PET or CT scanning and other invasive or noninvasive diagnostic tests [1]. There is also evidence that PET/CT is particularly effective if curative surgery is cancelled when PET/CT indicates advanced disease whereas conventional staging procedures suggest curable disease. Diagnostic effectiveness of PET/CT for staging NSCLC and differential diagnosis of solitary pulmonary nodules has been recently approved by many health care systems worldwide. Additional indications for cancer imaging which are recognized in the USA and several European countries include staging and restaging of oesophageal, colorectal and breast cancer, malignant lymphoma, melanoma and head and neck cancer [2]. Regarding these indications, a diagnostic effectiveness and superiority to conventional cancer imaging modalities has been demonstrated. However, if PET/CT is also cost-effective when integrated into routine diagnostic algorithms has never been demonstrated. In lung cancer, noninvasive imaging modalities contribute to only a small proportion of total health care costs (∼5–6%) [3]. However, given the limited resources of health care systems, evidence for economic efficiency of novel diagnostic tools or therapeutics will become more relevant in the near future. …