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Role of C11-FDG dual-tracer PET-CT scan in metastatic screening of hepatocellular carcinoma—a cost-effectiveness analysis
- Source :
- Hepatobiliary Surg Nutr
- Publication Year :
- 2021
- Publisher :
- AME Publishing Company, 2021.
-
Abstract
- Background: We aimed to identify predictive factors for positron emission tomography (PET)-detected hepatocellular carcinoma (HCC) metastasis and a cost-effective approach to preoperative PET-computed tomography (CT) for detecting metastasis. Methods: Clinicopathological and survival data of HCC patients having PET-CT with 18F-fludeoxyglucose (FDG) and 11C-acetate (ACT) following contrast-enhanced CT/magnetic resonance imaging (MRI) for preoperative tumor staging were reviewed. Binary logistic regression was performed to identify predictive factors for PET-detected metastasis. A cost-benefit analysis model was built for the incurred costs and the impact of PET-CT findings on treatment strategy was studied. Results: Totally 152 patients were analyzed. Dual-tracer PET-CT detected metastasis in 17 patients (11%). By multivariate analysis, alpha-fetoprotein (AFP) ≥400 ng/mL [relative risk (RR): 4.30, 95% confidence interval (CI): 1.41–13.15, P=0.011] and bilobar disease (RR: 3.94, 95% CI: 1.24–12.52, P=0.014) were independent predictive factors for PET-detected metastasis. PET-CT findings altered the treatment strategy for 12 patients (7.9%); three partial hepatectomies, eight episodes of transarterial chemoembolization (TACE) and one episode of ablation were avoided, with an estimated cost-saving of US $91,000, $150,000 and $10,600 respectively. Had the PET-CT been performed only for patients with AFP ≥400 ng/mL or bilobar disease (n=74), metastasis would have been confirmed in 14 patients (18.9%), and the cost-saving per patient was estimated at US $1,070. Conclusions: Dual-tracer PET-CT is cost-effective and useful for preoperative HCC staging in patients with AFP ≥400 ng/mL or bilobar disease. Its routine use in preoperative workup for all HCC patients is not recommended. Unilobar disease with AFP
- Subjects :
- medicine.medical_specialty
PET-CT
Multivariate analysis
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
medicine.disease
Confidence interval
Metastasis
03 medical and health sciences
0302 clinical medicine
Positron emission tomography
030220 oncology & carcinogenesis
Relative risk
Hepatocellular carcinoma
Medicine
Original Article
030211 gastroenterology & hepatology
Radiology
business
Subjects
Details
- ISSN :
- 2304389X and 23043881
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Hepatobiliary Surgery and Nutrition
- Accession number :
- edsair.doi.dedup.....23873a347195e614b1a7269120649edd
- Full Text :
- https://doi.org/10.21037/hbsn.2019.11.09