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Related Concept Videos

Positron Emission Tomography01:29

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Positron emission tomography (PET) is a medical imaging technique involving radiopharmaceuticals — substances that emit short-lived radiation. Although the first PET scanner was introduced in 1961, it took 15 more years before radiopharmaceuticals were combined with the technique and revolutionized its potential.
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Imaging Studies II: Positron Emission Tomography and Scintigraphy01:25

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Positron Emission Tomography (PET) is a medical imaging technique that provides crucial insights into the body's physiological functions at a molecular level. It is an indispensable resource for diagnosing, staging, and monitoring various illnesses, notably cancer, neurological disorders, and cardiovascular conditions.
Fundamental Principles of PET
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Gene Regulation and Targeted Therapy in Gastric Cancer Peritoneal Metastasis: Radiological Findings from Dual Energy CT and PET/CT
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FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial.

Elizabeth J de Koster1, Dennis Vriens2, Maarten O van Aken3

  • 1Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands. Lisanne.deKoster@radboudumc.nl.

European Journal of Nuclear Medicine and Molecular Imaging
|April 18, 2022
PubMed
Summary

[18F]FDG-PET/CT imaging is a cost-effective strategy for evaluating thyroid nodules with Bethesda III/IV cytology. This approach reduces diagnostic surgeries and associated costs while maintaining quality of life.

Keywords:
Cost-effectivenessCostsHealth-related quality of lifeIndeterminate thyroid noduleQALYThyroid carcinomaThyroid surgery[18F]FDG-PET/CT

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Area of Science:

  • Nuclear medicine
  • Oncology
  • Health economics

Background:

  • Thyroid nodules with Bethesda III/IV cytology present a diagnostic challenge, often leading to unnecessary surgeries.
  • [18F]FDG-PET/CT imaging offers a non-invasive method for evaluating these nodules.
  • Assessing the cost-effectiveness of [18F]FDG-PET/CT compared to diagnostic surgery is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup versus diagnostic surgery for thyroid nodules with Bethesda III/IV cytology.
  • To determine if [18F]FDG-PET/CT can reduce futile diagnostic surgeries for benign nodules.
  • To analyze the long-term societal costs and quality-adjusted life years (QALYs) associated with each diagnostic approach.

Main Methods:

  • A randomized controlled multicentre trial involving 132 patients compared [18F]FDG-PET/CT to diagnostic surgery.
  • Lifelong societal costs and QALYs were assessed using a Markov model based on 1-year trial results.
  • Cost-effectiveness acceptability curves were used to estimate the probability of cost-effectiveness, accounting for uncertainties.

Main Results:

  • The [18F]FDG-PET/CT workup resulted in a 1-year cost reduction of €1000 for thyroid nodule-related care and €4500 from a societal perspective.
  • Over a modeled lifelong period, the cost difference was -€9900, with a QALY difference of 0.402.
  • At a willingness to pay of €50,000 per QALY, [18F]FDG-PET/CT was the cost-effective strategy with 84% certainty.

Conclusions:

  • An [18F]FDG-PET/CT-driven diagnostic workup significantly reduces costs for thyroid nodule management in Bethesda III/IV cases.
  • This imaging approach avoids unnecessary surgeries, thereby lowering healthcare expenditures and improving patient outcomes.
  • [18F]FDG-PET/CT is a highly probable cost-effective strategy compared to diagnostic surgery for Bethesda III/IV thyroid nodules.