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Burian E, Palla B, Callahan N, Pyka T, Wolff C, von Schacky CE, Schmid A, Froelich MF, Rübenthaler J, Makowski MR, Gassert FG. Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis. Eur J Nucl Med Mol Imaging 2022; 49:3870-3877. [PMID: 35606526 PMCID: PMC9399011 DOI: 10.1007/s00259-022-05843-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Treatment of oral squamous cell carcinoma (OSCC) is based on clinical exam, biopsy, and a precise imaging-based TNM-evaluation. A high sensitivity and specificity for magnetic resonance imaging (MRI) and F-18 FDG PET/CT are reported for N-staging. Nevertheless, staging of oral squamous cell carcinoma is most often based on computed tomography (CT) scans. This study aims to evaluate cost-effectiveness of MRI and PET/CT compared to standard of care imaging in initial staging of OSCC within the US Healthcare System. Methods A decision model was constructed using quality-adjusted life years (QALYs) and overall costs of different imaging strategies including a CT of the head, neck, and the thorax, MRI of the neck with CT of the thorax, and whole body F-18 FDG PET/CT using Markov transition simulations for different disease states. Input parameters were derived from literature and willingness to pay (WTP) was set to US $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Monte Carlo modeling was used for probabilistic sensitivity analysis. Results In the base-case scenario, total costs were at US $239,628 for CT, US $240,001 for MRI, and US $239,131 for F-18 FDG PET/CT whereas the model yielded an effectiveness of 5.29 QALYs for CT, 5.30 QALYs for MRI, and 5.32 QALYs for F-18 FDG PET/CT respectively. F-18 FDG PET/CT was the most cost-effective strategy over MRI as well as CT, and MRI was the cost-effective strategy over CT. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with incremental cost effectiveness ratio remaining below US $100,000/QALY for a wide range of variability of input parameters. Conclusion F-18 FDG PET/CT is the most cost-effective strategy in the initial N-staging of OSCC when compared to MRI and CT. Despite less routine use, both whole body PET/CT and MRI are cost-effective modalities in the N-staging of OSCC. Based on these findings, the implementation of PET/CT for initial staging could be suggested to help reduce costs while increasing effectiveness in OSCC.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas Pyka
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Constantin Wolff
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudio E von Schacky
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Annabelle Schmid
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Dieng M, Lord SJ, Turner RM, Nieweg OE, Menzies AM, Saw RPM, Einstein AJ, Emmett L, Thompson JF, Lo SN, Morton RL. The Impact of Surveillance Imaging Frequency on the Detection of Distant Disease for Patients with Resected Stage III Melanoma. Ann Surg Oncol 2022; 29:2871-2881. [PMID: 35142966 PMCID: PMC8990943 DOI: 10.1245/s10434-021-11231-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is not known whether there is a survival benefit associated with more frequent surveillance imaging in patients with resected American Joint Committee on Cancer stage III melanoma. OBJECTIVE The aim of this study was to investigate distant disease-free survival (DDFS), melanoma-specific survival (MSS), post distant recurrence MSS (dMSS), and overall survival for patients with resected stage III melanoma undergoing regular computed tomography (CT) or positron emission tomography (PET)/CT surveillance imaging at different intervals. PATIENTS AND METHODS A closely followed longitudinal cohort of patients with resected stage IIIA-D disease treated at a tertiary referral center underwent 3- to 4-monthly, 6-monthly, or 12-monthly surveillance imaging between 2000 and 2017. Survival outcomes were estimated using the Kaplan-Meier method, and log-rank tests assessed the significance of survival differences between imaging frequency groups. RESULTS Of 473 patients (IIIA, 19%; IIIB, 31%; IIIC, 49%; IIID, 1%) 30% underwent 3- to 4-monthly imaging, 10% underwent 6-monthly imaging, and 60% underwent 12-monthly imaging. After a median follow-up of 6.2 years, distant recurrence was recorded in 252 patients (53%), with 40% detected by surveillance CT or PET/CT, 43% detected clinically, and 17% with another imaging modality. Median DDFS was 5.1 years (95% confidence interval 3.9-6.6). Among 139 IIIC patients who developed distant disease, the median dMSS was 4.4 months shorter in those who underwent 3- to 4-monthly imaging than those who underwent 12-monthly imaging. CONCLUSION Selecting patients at higher risk of distant recurrence for more frequent surveillance imaging yields a higher proportion of imaging-detected distant recurrences but is not associated with improved survival. A randomized comparison of low versus high frequency imaging is needed.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Robin M Turner
- Centre for Biostatistics, University of Otago, Dunedin, New Zealand
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Jaeger ZJ, Williams GA, Chen L, Mhlanga JC, Cornelius LA, Fields RC. 18 F-FDG positron emission tomography-computed tomography has a low positive predictive value for detecting occult recurrence in asymptomatic patients with high-risk Stages IIB, IIC, and IIIA melanoma. J Surg Oncol 2022; 125:525-534. [PMID: 34741547 PMCID: PMC8799500 DOI: 10.1002/jso.26737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES High recurrence rates of Stages II and IIIA melanoma make close follow-up essential, especially with new adjuvant therapies for metastatic disease. However, there are currently no consensus guidelines for routine imaging for Stages IIB, IIC, and IIIA melanoma. The study's aim is to determine the utility of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting asymptomatic recurrence of melanoma after primary surgical resection. METHODS This retrospective cohort study included 158 patients with the American Joint Committee on Cancer 8th edition Stages IIB, IIC, or IIIA cutaneous melanoma who underwent an 18 F-FDG PET/CT from 2010 to 2020. We retrospectively analyzed clinical data after a median follow-up time of 39 months. RESULTS We calculated a positive predictive value (PPV) of 32% (95% confidence interval: 11%-53%) for 154 routine PET/CTs, including six true positives and 13 false positives (FPs). PPV was 33% for Stage IIB, 50% for Stage IIC, and 14% for Stage IIIA. FPs were mostly benign or inflammatory foci (75%), and some other malignancies were found (21%). CONCLUSIONS This cohort of patients imaged for high-risk melanoma demonstrated a high FP rate and low PPV. These findings suggest that routine surveillance with 18 F-FDG PET/CT may not be indicated for monitoring recurrence in this population.
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Affiliation(s)
| | - Gregory A. Williams
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine
- Alvin J. Siteman Comprehensive Cancer Center
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine
| | - Joyce C. Mhlanga
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - Lynn A. Cornelius
- Alvin J. Siteman Comprehensive Cancer Center
- Division of Dermatology, Department of Medicine, Washington University School of Medicine
| | - Ryan C. Fields
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine
- Alvin J. Siteman Comprehensive Cancer Center
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Dieng M, Turner RM, Lord SJ, Einstein AJ, Menzies AM, Saw RPM, Nieweg OE, Thompson JF, Morton RL. Cost-Effectiveness of PET/CT Surveillance Schedules to Detect Distant Recurrence of Resected Stage III Melanoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042331. [PMID: 35206519 PMCID: PMC8872338 DOI: 10.3390/ijerph19042331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
Objective: To estimate the cost-effectiveness of three surveillance imaging strategies using whole-body positron emission tomography (PET) with computed tomography (CT) (PET/CT) in a follow-up program for adults with resected stage III melanoma. Methods: An analytic decision model was constructed to estimate the costs and benefits of PET/CT surveillance imaging performed 3-monthly, 6-monthly, or 12-monthly compared with no surveillance imaging. Results: At 5 years, 3-monthly PET/CT surveillance imaging incurred a total cost of AUD 88,387 per patient, versus AUD 77,998 for 6-monthly, AUD 52,560 for 12-monthly imaging, and AUD 51,149 for no surveillance imaging. When compared with no surveillance imaging, 12-monthly PET/CT imaging was associated with a 4% increase in correctly diagnosed and treated distant disease; a 0.5% increase with 6-monthly imaging and 1% increase with 3-monthly imaging. The incremental cost-effectiveness ratio (ICER) of 12-monthly PET/CT surveillance imaging was AUD 34,362 for each additional distant recurrence correctly diagnosed and treated, compared with no surveillance imaging. For the outcome of cost per diagnostic error avoided, the no surveillance imaging strategy was the least costly and most effective. Conclusion: With the ICER for this strategy less than AUD 50,000 per unit of health benefit, the 12-monthly surveillance imaging strategy is considered good value for money.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
- Correspondence:
| | - Robin M. Turner
- Biostatistics Centre, Otago University, Dunedin 9016, New Zealand;
| | - Sarah J. Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
| | - Andrew J. Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY 10032, USA;
| | - Alexander M. Menzies
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, North Sydney 2060, Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Omgo E. Nieweg
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - John F. Thompson
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown 2050, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia; (S.J.L.); (R.L.M.)
- Melanoma Institute Australia, North Sydney 2060, Australia; (A.M.M.); (R.P.M.S.); (O.E.N.); (J.F.T.)
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