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dc.contributor.authorGilbert, Fiona
dc.contributor.authorHarris, Scott
dc.contributor.authorMiles, Kenneth A
dc.contributor.authorWeir-McCall, Jonathan
dc.contributor.authorQureshi, Nagmi R
dc.contributor.authorRintoul, Robert
dc.contributor.authorDizdarevic, Sabina
dc.contributor.authorPike, Lucy
dc.contributor.authorSinclair, Donald
dc.contributor.authorShah, Andrew
dc.contributor.authorEaton, Rosemary
dc.contributor.authorJones, Jeremy
dc.contributor.authorClegg, Andrew
dc.contributor.authorBenedetto, Valerio
dc.contributor.authorHill, James
dc.contributor.authorCook, Andrew
dc.contributor.authorTzelis, Dimitrios
dc.contributor.authorVale, Luke
dc.contributor.authorBrindle, Lucy
dc.contributor.authorMadden, Jackie
dc.contributor.authorCozens, Kelly
dc.contributor.authorLittle, Louisa
dc.contributor.authorEichhorst, Kathrin
dc.contributor.authorMoate, Patricia
dc.contributor.authorMcClement, Chris
dc.contributor.authorPeebles, Charles
dc.contributor.authorBanerjee, Anindo
dc.contributor.authorHan, Sai
dc.contributor.authorPoon, Fat-Wui
dc.contributor.authorGroves, Ashley M
dc.contributor.authorKurban, Lutfi
dc.contributor.authorFrew, Anthony
dc.contributor.authorCallister, Matthew EJ
dc.contributor.authorCrosbie, Phil A
dc.contributor.authorGleeson, Fergus Vincent
dc.contributor.authorKarunasaagarar, Kavitasagary
dc.contributor.authorKankam, Osei
dc.contributor.authorGeorge, Steve
dc.description.abstractINTRODUCTION: Dynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these. METHODS: In this prospective multicentre trial, 380 participants with an SPN (8-30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model. RESULTS: 312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred. CONCLUSIONS: PET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective. TRIAL REGISTRATION NUMBER: NCT02013063.
dc.description.sponsorshipThe trial is funded by the NIHR HTA Programme (grant no: 09/22/117) and is being run by Southampton Clinical Trials Unit who are part funded by CRUK. AJC, VB and JEH are part-funded by the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). FJG is an NIHR Senior Investigator. RCR is part funded by the Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre and the Cancer Research Network: Eastern. NRQ is part funded by the Cambridge Biomedical Research Centre. Part of the current works was performed at Cambridge which receives a portion of its funding form the UK's NIHR Biomedical Centre funding scheme. Part of the current works was performed at UCL/H which receives a portion of its funding form the UK's NIHR Biomedical Centre funding scheme.
dc.rightsAttribution-NonCommercial 4.0 International
dc.titleComparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules.
dc.contributor.orcidGilbert, Fiona [0000-0002-0124-9962]
dc.contributor.orcidWeir-McCall, Jonathan [0000-0001-5842-842X]
dc.contributor.orcidRintoul, Robert [0000-0003-3875-3780]
dc.contributor.orcidCrosbie, Phil A [0000-0001-8941-4813]
rioxxterms.typeJournal Article/Review
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10067)
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (146281)
cam.orpheus.successTue Feb 01 19:02:22 GMT 2022 - Embargo updated*

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Attribution-NonCommercial 4.0 International
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