Healthcare Improvement Scotland, SHTG team, December 2017
Key Points
- Renal cancer
- In a meta-analysis of seven studies (n=535), 18F-fluorodeoxyglucose (FDG) PET-CT had a pooled sensitivity of 0.88 (95% confidence interval (CI) 0.84 to 0.91) and pooled specificity of 0.88 (95% CI 0.82 to 0.92) for restaging of renal cell carcinoma.
- One retrospective study reported that, following FDG PET-CT, patient management was altered for 43% (n=45) of patients with suspected renal cell carcinoma recurrence or metastases. In the same study, a positive FDG PET-CT finding was associated with statistically significantly lower 3-year progression-free survival (20% versus 67%, p<0.05) and 5-year overall survival (19% versus 69%, p=0.05) compared with a negative FDG PET-CT finding.
- Bladder cancer
- A meta-analysis of seven studies (n=253) reported diagnostic accuracy for FDG PET-CT separately for primary staging and restaging/metastases detection in patients with suspected bladder cancer:
- primary staging (two studies) - pooled sensitivity was 0.9 (95% CI 0.70 to 0.99) and pooled specificity was 1.00 (95% CI 0.74 to 1.00) and
- restaging/metastases (five studies) - pooled sensitivity was 0.82 (95% CI 0.72 to 0.89) and pooled specificity was 0.89 (95% CI 0.84 to 0.95).
- Four observational studies (n=293) reported a change in patient management in 20-47% of patients with bladder cancer based on FDG PET-CT findings.
- In one of these studies (retrospective, n=41), a positive FDG PET-CT result was associated with lower 2-year survival (47% versus 88%, p<0.05) 3-year survival (25% versus 87%, p<0.05), and 2-year progression-free survival (24% versus 85%, p<0.05) compared with a negative FDG PET-CT finding in patients with suspected recurrence or metastases of bladder cancer.
- No evidence was identified which assessed the cost effectiveness of FDG PET-CT in patients with urological cancers. Therefore, no conclusions can be drawn about the cost effectiveness of FDG PET-CT in this patient group.
