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Nuklearmedizin 2003; 42(04): 145-156
DOI: 10.1055/s-0038-1625184
Original Article
Schattauer GmbH

18F-Fluorodeoxyglucose positron emission tomography in restaging of colorectal cancer

Evidence-based recommendations and cost-effectiveness 18F-FluordeoxyglukosePositronenemissionstomographie in der Rezidivdiagnostik des kolorektalen KarzinomsEvidenzbasierte Empfehlungen und Kosten/Nutzenabwägungen
M. Dietlein
1   Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. H. Schicha) der Universität zu Köln
,
W. Weber
2   Nuklearmedizinische Klinik (Direktor: Prof. Dr. M. Schwaiger) der Technischen Universität München, Klinikum rechts der Isar, Deutschland
,
M. Schwaiger
2   Nuklearmedizinische Klinik (Direktor: Prof. Dr. M. Schwaiger) der Technischen Universität München, Klinikum rechts der Isar, Deutschland
,
H. Schicha
1   Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. H. Schicha) der Universität zu Köln
› Author Affiliations
Further Information

Publication History

Eingegangen: 14 February 2003

in revidierter Form: 20 May 2003

Publication Date:
10 January 2018 (online)

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Summary:

Aim, method: Recommendations for the use of FDG-PET in relapsed colorectal cancer and the decision of reimbursement should base on published studies and on their level of evidence. Therefore, the PET-studies published between 1997 and 2002 were graded by the bias-criteria, by two rating-systems and by two classification-systems for the level of evidence according to AHCPR (Agency for Health Care Policy and Research) and VHA (Veterans Health Administration). Results: The recommendation for the use of PET in relapsed colorectal cancer reached the level IIa according to the AHCPR, corresponding to level B according to the VHA. The sensitivity and specificity of FDG-PET were 94% (95% CI: 91-96%) and 78% (95% CI: 69-86%), respectively. Staging was changed correctly in 27% of patients (95% CI: 24-30%). Staging by FDG-PET was incorrect in 4% of the patients (95% CI: 2-5%) compared with the conventionel methods. The additional use of PET changed the prospectively defined management plan for 34% of patients (95% CI: 31-38%). Either potentially curative operations were initiated in case of resectable tumour or futile operations were cancelled in case of multiple metastases. Conclusion: The 3-year-survival-rate following surgery would have exceeded 70% if the selection of patients had included an additional PET-examination. The correct selection of patients is requested in the daily routine as well as in the clinical implementation of neoadjuvant therapies to prevent a selection-bias from a suboptimal restaging without PET.

Zusammenfassung:

Ziel, Methode: Empfehlungen zum Einsatz der FDG-PET in der Rezidivdiagnostik des kolorektalen Karzinoms müssen sich für eine Kostenübernahme durch die Gesetzlichen Krankenkassen am Evidenzgrad der publizierten Studien messen lassen. Deshalb wurden anhand der Bias-Formen, zweier Rating-Systeme sowie der Kriterienkataloge der AHCPR (Agency for Health Care Policy and Research) und der VHA (Veterans Health Administration) die zwischen 1997 und 2002 publizierten Studien analysiert. Ergebnisse: Hierbei erreichten die Empfehlungen zugunsten der PET bei begründetem Rezidivverdacht eines kolorektalen Karzinoms den Evidenzgrad IIa nach der AHCPR-Klassifikation/Ausschuss Krankenhaus bzw. den Evidenzgrad B nach der VHA-Klassifikation. Die Sensitivität und Spezifität der FDG-PET lag bei 94% (95%-Konfidenzinterval: 91-96%) bzw. bei 78% (95%-KI: 69-86%). Die Änderung des Stagings durch die FDG-PET war bei 27% der Patienten (95%-KI: 24-30%) zutref-fend bzw. bei 4% der Patienten (95%-KI: 2-5%) nicht zutreffend, wenn die konventionelle Diagnostik als Vergleichsmaßstab diente. Des Weiteren wurde die Effektivität der PET hinsichtlich einer stadiengerechten Therapieentscheidung untersucht: Hierbei führte die PET bei 34% der Patienten (95%-KI: 31-38%) zu einer relevanten Änderung eines zuvor festgelegten Therapiekonzeptes. Dies betraf zum einen die Initiierung einer potenziell kurativen Operation als auch die Vermeidung einer nicht kurativen Operation bei multiplen Metastasen. Schlussfolgerungen: Hohe 3-Jahres-Überlebensraten von über 70% in der Rezidivchirurgie beruhen auf einer besseren Absicherung der Operationsindikation mittels additiver PET. Die zutreffende Auswahl der Patienten für den Chirurgen und den Onkologen dient der Krankenversorgung sowie der Implementierung neoadjuvanter und additiver Therapiekonzepte, wobei Therapiestudien nicht durch eine suboptimale Diagnostik (Selektionsbias) ohne PET kompromittiert werden sollten.

Key words:

PET - FDG - colorectal cancer - evidence based medicine - cost-effectiveness

Schlüsselwörter:

PET - FDG - kolorektales Karzinom - evidenzbasierte Medizin - Kosteneffektivität
 

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