Fusion changes patient management with PET & C

Abstract

702 Background: Growing emphasis is placed on “fusion” of slices from Computed Tomography (CT) and Positron Emission Tomography (PET). 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET imaging has proven to be more accurate than conventional imaging in the staging and restaging of breast cancer. With “fused” images unique metabolic information from PET, with the simultaneously anatomic information from CT is useful for anatomic localization. Methods: Eligibility included referrals from physicians of patients for staging or restaging of breast cancer with FDG PET. The treatment was based on the use of a Philip's Allegro PET scanner. The primary endpoints were to determine the per cent change in patient management as well as sensitivity, specificity and accuracy. Follow up phone calls to referring physicians were made inquiring how PET findings altered clinical management decisions. Breast cancer patient's CT findings were compared to PET for accuracy, specificity and sensitivity. Results: The accrual of data demonstrated that 19 patients' CTs were co-registered for “fusion” with corresponding slices from whole body PET studies. The subsequent 3-D co-registration of the respective data sets provided unique information. Specifically, six patients were upstaged and four were down staged based on the recognition of false positive/negative PET findings and/or false positive/negative CT. Follow-up with referring physicians occurred over the twelve month period and the change in patient management averaged 30% with a confidence level of plus or minus 3%. Analysis included phone surveys of referring physicians inquiring about altered clinical management decisions of their patients and patient chart review. In our study, a 3-D software approach was utilized to “fuse” image data acquired at separate locations optimizing the two studies as they occur in the natural progression of referral algorithms. Conclusions: 34 cases with diagnosed breast cancer were referred for FDG PET imaging over a 12 month period. With PET studies a change in patient management occurred 30% of the time. Overall, PET studies were 90% more sensitive, 85% more specific, and 87% more accurate compared to CT. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Fusion Diagnostic Group