Enhancing the effectiveness of health care ICES Institute for Clinical for Ontarians through research ja Sciences Health Technology Assessment of Positron Emission Tomography (PET) in Oncology - A Systematic Review & | j } ae ICES Investigative Report Quarterly Update - April 2004PET Literature review and assessment of articles: Last updated April 2004 Our original report, “Health Technology Assessment of Positron Emission Tomography” was published on May 31, 2001. The report presented the results of a systematic review of the peer- reviewed, gray and web-based PET scanning literature up to December 2000 and is also available in the “investigative report” section of our website. Since that time, we have posted regular updates relative to PET scanning The last update was posted on our website in January 2004. This current report has been updated to include literature published up to and including April 1, 2004. As in previous reports, the current update focuses exclusively on clinical applications of PET among 6 commonly occurring categories of cancer. carcinoma of the lung, colorectal carcinoma, squamous carcinoma of the head and neck, carcinoma of the breast, malignant lymphoma, and malignant melanoma. The comprehensive results of our reviews are presented below. If you have any comments or questions please do not hesitate to contact Susan Garfinkel, Research Coordinator, 416-480-4055 ext. 2869. (mailto:susan garfinkel@ices.on.ca) New in this report + Axecent study was published by the American College of Surgeons Oncology Group in 2003. A total of 445 patients from 22 institutions in the United States were registered in the study if they had a suspected or confirmed diagnosis of NSCLC and were deemed to be surgical candidates based on routine staging procedures. Following various patient climinations (eg. use of inappropriate consent form in 70 patients, ineligibility determined in 60 patients), 287 patients were evaluated using PET. Compared to CT, PET better detected NI disease (42% vs. 13%) and N2/N3 disease (58% vs. 32%). For mediastinal node disease the negative predictive value of PET was 87% (vs. 81% for CT) and the positive predictive value of PET was 56% (ws. 58% for CT)? In 157 patients with suspected non-small cell lung cancer, the sensitivity of FDG PET was reported to be similar to that of °™Tc depreotide (96% vs. 94%), whereas the specificity of FDG PET was higher (71% vs. 51%). The accuracy of staging of FDG PET and °™Tc depreotide was similar, in 139 patients with complete staging available (55% vs. 45% respectively)? ¢ FDG-PET was reported to have moderate accuracy, compared against axillary node pathology, for detecting auillary metastases in 360 women with newly diagnosed invasive breast cancer (308 with assessable axillae). The mean sensitivity and specificity of PET (with at least one abnormal axillary focus considered to be positive) was 61% and 80%, respectively. Under these same conditions, the positive and negative predictive value for PET was 62% and 79%, respectively. The authors concluded that PET should not be “routinely recommended” for axillary staging in newly diagnosed breast cancer. ? April 2004 1 PET Literature Review@ Asenes of 200 patients with breast cancer were studied with FDG PET. One hundred patients had axillary dissection (regardless of PET results). The sensitivity, specificity, positive predictive value and negative predictive value of PET in this group was 90.9, 100, 100 and 90%, respectively. The other 100 patients had a subsequent sentinel node biopsy (Gn the absence of suspicious axilla in the PET scan). The sensitivity, specificity, positive predictive value and negative predictive value of PET in this group was 76.9, 95.8, 95.2, and 79.3, respectively. The authors concluded that FDG-PET can avoid routine sentinel node study in breast cancer cases where there is axillary uptake, but should be complemented by sentinel node biopsy where there is no pathological uptake on FDG-PET* April 2004 2