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Dominique Delbeke,
R Edward Coleman,
Milton J Guiberteau,
Manuel L Brown,
Henry D Royal,
Barry A Siegel,
David W Townsend,
Lincoln L Berland,
J Anthony Parker, Karl Hubner,
Michael G Stabin,
George Zubal,
Marc Kachelriess,
Valerie Cronin,
Scott Holbrook
Journal of Nuclear Medicine 06/2006; 47(5):885-95. · 6.38 Impact Factor
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ABSTRACT: Monte Carlo simulation analysis was used to compare the cost of managing recurrent ovarian cancer patients with and without the use of positron emission tomography (PET) scanning. Assumptions in the management pathway were: (1) a positive PET scan led to either laparoscopy or laparotomy, followed by chemotherapy (true positive PET) or follow-up (false positive PET); (2) a negative PET scan resulted in continued follow-up (true negative PET) or laparotomy (false negative PET); and, (3) a laparotomy led to chemotherapy or follow-up. In this simulation, sensitivity and specificity of FDG PET for recurrent ovarian cancer varied from 72-91% (mean 83%) and 69-95% (mean 85%), respectively, as defined by the ROC curve. Using a prevalence rate of 30% for recurrent ovarian cancer, the mean PET false negative rate was 5%. Thus, when using PET to manage the diagnostic evaluation, the number of unnecessary laparotomies was reduced from 70% to 5%, with 35% of patients undergoing laparoscopy for recurrent disease instead of laparotomy. If laparotomy is used in place of laparoscopy, unnecessary surgery can be avoided in 30% of patients. Costs for procedures were based both on hospital charges, and Medicare reimbursement rates. Cost savings per patient ranged from $1,941 to $11,766, assuming that follow-up evaluation was similar for both groups. Estimated cost savings were due to the need for fewer surgical procedures when using PET in the diagnostic evaluation, the reimbursement rate scheme employed, and whether laparotomy or laparoscopy was used in the management algorithm for PET positive patients. In conclusion, FDG PET can reduce unnecessary invasive staging procedures and save health care costs when used appropriately in the management of patients with recurrent ovarian cancer.
Clinical Positron Imaging 04/1999; 2(2):63-70.
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ABSTRACT: Useful characterizing parameters have been derived from historical positron emission tomography (PET) standardized uptake values (SUV) and influx constants K. Meta-analysis was performed on 30 multipatient PET oncological studies providing same patient SUVs and K's. Averaged results for fluorine-18 fluorodeoxyglucose (FDG) and L-methionine respectively were: SUV vs. K correlation coefficients = 0.89 and 0.80; SUV/K ratios = 192 and 63 minutes as average tracer clearance times T in these populations. For cancers, coefficients of variation (CV) for K's were 0.61 and 0.46, notably larger than the CVs (0.50 and 0.40) for SUVs. A Monte Carlo simulation model, matching these results, represents 1/T as (an effective tracer clearance rate) x (its initial distribution volume). We conclude that T is a characteristic tracer clearance time that is independent of cancer type. A measurement model is introduced that might help improve protocols. The higher CVs of K's vs. SUVs is worth noting clinically when seeking an effective diagnostic marker. Also, SUV conversions to K can provide some quality assurance in K measurements.
Clinical Positron Imaging 04/1999; 2(2):99-104.
