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Practice-based evidence for the clinical benefit of PET/CT—results of the first oncologic PET/CT registry in Germany

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the impact of PET/CT on clinical management of cancer patients based on a prospective data registry. The study was developed to inform consultations with public health insurances on PET/CT coverage.

Methods

We evaluated a prospective patient cohort having a clinically indicated PET/CT at a single German University Center from April 2013 to August 2016. The registry collected questionnaire data from requesting physicians on intended patient management before and after PET/CT. A total of 4,504 patients with 5,939 PET/CT examinations were enrolled in the registry, resulting in evaluable data from 3,724 patients receiving 4,754 scans. The impact of PET/CT on patient management was assessed across 22 tumor types, for different indications (diagnosis, staging, suspected recurrence) and different categories of management including treatment (curative or palliative) and non-treatment (watchful waiting, additional imaging, invasive tests).

Results

The most frequent PET/CT indication was tumor staging (59.7%). Melanoma, lung cancer, lymphoma, neuroendocrine tumor and prostate cancer accounted for 70% of cases. Overall, the use of PET/CT resulted in a 37.1% change of clinical management (95% CI, 35.7–38.5), most frequently (30.6%) from an intended non-treatment strategy before PET/CT to active treatment after PET/CT. The frequency of changes ranged from 28.3% for head and neck cancers up to 46.0% for melanomas. The impact of PET/CT was greatest in reducing demands for additional imaging which decreased from 66.1% before PET/CT to 6.1% after PET/CT. Pre-PET/CT planned invasive tests could be avoided in 72.7% of cases. The treatment goal changed after PET/CT in 21.7% of cases, in twice as many cases from curative to palliative therapy than vice versa.

Conclusions

The data of this large prospective registry confirm that physicians often change their intended management on the basis of PET/CT by initiating treatment and reducing additional imaging as well as invasive tests. This applies to various cancer types and indications.

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Acknowledgements

First, we would like to thank all patients who agreed to participate in the registry. Furthermore we want to thank the staff of the PET/CT center and Radiopharmacy of the Tuebingen University for the continuous support in patient care. Special thanks go to our study nurses and staff members of the Institute of Biometry for their dedicated service in data administration. Last but not least we thank the many individuals at in-house and out-patient care and regional health insurance company (AOK) who contributed to the development of the first German PET/CT registry.

Funding

Financial support of the study evaluation was provided through the Wilhelm Sander Foundation (Wilhelm Sander-Stiftung, Goethestraße 74, 80336 Munich, Germany), project-number 2015.176.1.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Christina Pfannenberg, Brigitte Gueckel, Sergios Gatidis, Susann-Cathrin Olthof & Konstantin Nikolaou

  2. Institute of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University Tuebingen, Tübingen, Germany

    Lisa Wang & Peter Martus

  3. Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland

    Werner Vach

  4. Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University Tuebingen, Tübingen, Germany

    Matthias Reimold & Christian la Fougere

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  1. Christina Pfannenberg
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  2. Brigitte Gueckel
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Corresponding author

Correspondence to Christina Pfannenberg.

Ethics declarations

Conflict of interest

K.N. is on the speakers bureau of Bracco, Bayer and Siemens. The institution has cooperative research grants from Bayer and Siemens. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study was approved by the Ethics committee of the University of Tuebingen, reference number 064/2013B01.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Fig. 1

(a) Pre-PET/CT questionnaire and (b) post-PET/CT questionnaire (english translation) (PNG 363 kb)

High resolution image (TIF 690 kb)

(PNG 328 kb)

High resolution image (TIF 604 kb)

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Pfannenberg, C., Gueckel, B., Wang, L. et al. Practice-based evidence for the clinical benefit of PET/CT—results of the first oncologic PET/CT registry in Germany. Eur J Nucl Med Mol Imaging 46, 54–64 (2019). https://doi.org/10.1007/s00259-018-4156-3

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  • DOI: https://doi.org/10.1007/s00259-018-4156-3

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