Abstract
BackgroundPrevious studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. We aimed to describe the benefits of (PET) in the management of solitary pulmonary nodules (SPNs) in a population level, in terms of the number of diagnostic and invasive tests performed, time to diagnosis and factors determining PET utilization.MethodsIn an observational study, we examined reports of computed tomography (CT) performed and mentioning "spherical lesion", "nodule" or synonymous terms. We found 11,515 reports in a before-PET period, 2002–2003, and 20,075 in an after-PET period, 2004–2005. Patients were followed through their physician, who was responsible for diagnostic management.ResultsWe had complete data for 112 patients (73.7%) with new cases of SPN in the before-PET period and 250 (81.4%) in the after-PET period. Patients did not differ in mean age (64.9 vs. 64.8 years). The before-PET patients underwent a mean of 4 tests as compared with 3 tests for the after-PET patients (p = 0.08). Patients in the before-PET period had to wait 41.4 days, on average, before receiving a diagnosis as compared with 24.0 days, on average, for patients in the after-PET period who did not undergo PET (p < 0.001). In the after-PET period, 11% of patients underwent PET during the diagnostic process. A spiculated nodule was more likely to determine prescription for PET (p < 0.001). Multivariate analysis revealed that patients in both periods underwent fewer tests when PET was prescribed by general practitioners (p < 0.001) and if the nodule was not spiculated (p < 0.001). The proportion of unnecessary invasive approaches prescribed (47% vs. 49%) did not differ between the groups.ConclusionIn our study, 1 year after the availability of PET, the technology was not the first choice for diagnostic management of SPN. Even though we observed a tendency for reduced number of tests and mean time to diagnosis with PET, these phenomena did not fully relate to PET availability in health communities. In addition, the availability of PET in the management of SPN diagnosis did not reduce the overall rate of unnecessary invasive approaches.
Highlights
Previous studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging
We aimed to describe the modifications in the management of solitary pulmonary nodule (SPN) diagnosis in daily practice in terms of average number of tests performed, time to diagnosis and proportion of unnecessary invasive tests performed with PET availability in the 5 northeastern regions of France
We found that the mean number of diagnostic tests performed for the management of SPN diagnosis declined after PET was introduced into the northeastern regions of France, but the reduction was not statistically significant
Summary
Previous studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. A solitary pulmonary nodule (SPN) is a single spherical lesion < 3 cm in diameter completely surrounded by lung tissue without associated atelectasis or adenopathy [1,2] In most cases, it is detected incidentally by chest x-ray (CXR) imaging or computed tomography (CT). The management of SPN diagnosis consists of combinations of different approaches, invasive and/or noninvasive, from the moment SPN is identified by CXR or CT until the definitive diagnosis of its nature – malignant or benign This diagnostic approach depends on characteristics of patients (age, smoking history, antecedents of cancer) and nodules (size, location, spiculation, and calcification within the nodule). These characteristics determine the probability of malignancy [4,8]. One example of a malignant nodule is a new nodule of large size in an older patient with a heavy smoking history and CXR or CT results of a spiculated nodule pattern [9]
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