Abstract
BackgroundPositron emission tomography/computed tomography (PET/CT) scan is useful if clinically indicated. It is not for conventional routine use due to its high cost. Moreover, it can be confusing if ordered in non-indicated conditions. We evaluate if the pattern of PET/CT ordered in gastrointestinal cancers (non-colorectal origin) has followed evidence-based guidelines and whether it helped in the improvement of patient’s outcome. This study included non-colorectal gastrointestinal cancer patients from 2007 to 2008 who had one or more PET/CT scans done during their management. In each case, data collected revealed whether PET/CT affected the management or the stage or not. Patients were identified through the hospital tumor registry software CNExT (C/NET Solutions, Berkeley, CA). Tabulation and statistical data analysis were done using JMP-SAS statistical software application (version 9.4: SAS Institute, Cary, NC, USA). The scan report quality and use indications were outlined.ResultsSeventy-seven patients were identified, with 107 PET/CT scans done. Their median age is 59 (21–86) years. Males were 45 (58.5%). Tumor origin was 46.8% esophageal and gastroesophageal junction cancer, 15.6% gastric cancer, 11.7% pancreatic cancer, 11.7% hepatobiliary tumors, 10.4% neuroendocrine tumors, 2.6 % gastrointestinal stromal tumors, and 1.3% small bowel cancer. Indications of the PET/CT were as follows: staging in 59.8%, follow-up after finishing treatment in 14.9%, restaging at relapse in 8.4%, assessing response after/during treatment in 3.7%, follow-up of previous PET/CT in 12.1%, and others in 0.9%. PET/CT changed the stage in 19.6% and affected the management plan in 11.2% only. Fifty-two scans needed pathological pursuit as decided by investigators; of them, PET/CT for the lesions that could have changed the stage reported indeterminate/equivocal results in 32 (29.9%) of all scans. The pathological pursuit for the equivocal lesions on PET/CT scans was done in only 12 of 52 (23.1%) scans.ConclusionsLocal guidelines for ordering PET/CT scan are suggested because overuse was documented, and an evidence-based approach should be respected before its use.
Highlights
Positron emission tomography/computed tomography (PET/Computed tomography (CT)) scan is useful if clinically indicated
Two hundred thirty-seven patients were found with non-colorectal gastrointestinal cancers from January 1, 2007, to December 31, 2008
Investigators reviewed the clinical setting of each positron emission tomography (PET)/ CT scan, and as per their best clinical judgment, there was a need for pathological pursuit because findings were indeterminate in 52 scans; of them, Positron emission tomography/computed tomography (PET/CT) for the lesions that could have changed the stage reported indeterminate/equivocal results in 32 (29.9%) of all scans
Summary
Positron emission tomography/computed tomography (PET/CT) scan is useful if clinically indicated. It is not for conventional routine use due to its high cost. Computed tomography (CT) scanning and magnetic resonance (MR) imaging provide an important and necessary anatomical evaluation of the tumor, and on the other hand, positron emission tomography (PET) provides a functional evaluation that is, in many case scenarios, not less important. In the early 1970s, PET was developed, about the same time as MRI and after CT [3], and was introduced into clinical use in the 1990s It works by using natural molecules (e.g., glucose or amino acid) after labeling them with positron emitting radioisotopes. FDG (fluorodeoxyglucose) is a glucose analog, and it is the most widely used isotope, characterized by having a relatively long half-life of 110 min [4]
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