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Positron emission tomography with selected mediastinoscopy compared to routine mediastinoscopy offers cost and clinical outcome benefits for pre-operative staging of non-small cell lung cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is an important staging procedure in patients with non-small cell lung cancer (NSCLC). We aimed to demonstrate, through a decision tree model and the incorporation of real costs of each component, that routine FDG-PET imaging as a prelude to curative surgery will reduce requirements for routine mediastinoscopy and overall hospital costs.

Methods

A decision tree model comparing routine whole-body FDG-PET imaging to routine staging mediastinoscopy was used, with baseline variables of sensitivity, specificity and prevalence of non-operable and metastatic disease obtained from institutional data and a literature review. Costings for hospital admissions for mediastinoscopy and thoracotomy of actual patients with NSCLC were determined. The overall and average cost of managing patients was then calculated over a range of FDG-PET costs to derive projected cost savings to the community.

Results

The prevalence of histologically proven mediastinal involvement in patients with NSCLC presenting for surgical assessment at our institution is 20%, and the prevalence of distant metastatic disease is 6%. Based on literature review, the pooled sensitivity and specificity of FDG-PET for detection of mediastinal spread are 84% and 89% respectively, and for mediastinoscopy, 81% and 100%. The average cost of mediastinoscopy for NSCLC in our institution is AUD$4,160, while that of thoracotomy is AUD$15,642. The cost of an FDG-PET scan is estimated to be AUD$1,500. Using these figures and the decision tree model, the average cost saving is AUD$2,128 per patient.

Conclusion

Routine FDG-PET scanning with selective mediastinoscopy will save AUD$2,128 per patient and will potentially reduce inappropriate surgery. These cost savings remain robust over a wide range of disease prevalence and FDG-PET costs.

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Acknowledgements

This work was supported in part by a National Health and Medical Research Council Project Grant No. 950881. The authors acknowledge the contribution of Ms Jayne Ramshaw, of Diagnosis Pty Ltd, for her assistance in this project.

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Authors and Affiliations

  1. Centre for PET, University of Melbourne, Austin Hospital, Heidelberg, Victoria, 3084, Australia

    Kelvin K. Yap, Kenneth S. K. Yap, Amanda J. Byrne, Salvatore U. Berlangieri, Aurora Poon, Anthony Harris, Andrew Tauro, Christopher C. Rowe & Andrew M. Scott

  2. Ludwig Institute for Cancer Research, University of Melbourne, Austin Hospital, Heidelberg, Victoria, 3084, Australia

    Paul Mitchell & Andrew M. Scott

  3. Department of Thoracic Surgery, University of Melbourne, Austin Hospital, Heidelberg, Victoria, 3084, Australia

    Simon R. Knight & Peter C. Clarke

  4. Department of Medicine, University of Melbourne, Austin Hospital, Heidelberg, Victoria, 3084, Australia

    Christopher C. Rowe & Andrew M. Scott

  5. Center for PET, Austin Hospital, Level 1 HSB, Studley Rd, Heidelberg, Victoria, 3084, Australia

    Andrew M. Scott

Authors
  1. Kelvin K. Yap
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  2. Kenneth S. K. Yap
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  3. Amanda J. Byrne
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  4. Salvatore U. Berlangieri
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  5. Aurora Poon
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  6. Paul Mitchell
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  7. Simon R. Knight
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  8. Peter C. Clarke
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  9. Anthony Harris
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  10. Andrew Tauro
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  11. Christopher C. Rowe
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  12. Andrew M. Scott
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Corresponding author

Correspondence to Andrew M. Scott.

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Yap, K.K., Yap, K.S.K., Byrne, A.J. et al. Positron emission tomography with selected mediastinoscopy compared to routine mediastinoscopy offers cost and clinical outcome benefits for pre-operative staging of non-small cell lung cancer. Eur J Nucl Med Mol Imaging 32, 1033–1040 (2005). https://doi.org/10.1007/s00259-005-1821-0

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  • DOI: https://doi.org/10.1007/s00259-005-1821-0

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