Molecular Imaging Insight - June 2008 - (Page 5)

sufficiently randomized cohort, as Hillner noted. However, meta-analysis of research from single-site and multisite studies, are providing indications for a wider role in the utilization of molecular imaging. Rahain Hussain, MD, of the Institute of Nuclear Medicine and Ultrasound in Dhaka, Bangladesh, and John Buscombe, MD, of the department of nuclear medicine, at Royal Free Hospital in London, used an on-line, literature-based approach to the evidence basis for scintimammography. Their results, published in the journal Nuclear Medicine Communications (July 2006), reviewed outcomes for 2,424 patients from single-center trials and 3,049 patients from multicenter trials on scintimammography conducted with 99mTc MIBI-labeled isonitriles. They only included studies conducted after 1997, to ensure that the data were from exams conducted after the procedure had become mature. They found that the procedure had an overall sensitivity of 85 percent and a specificity of 84 percent. They were not able to determine patient outcomes or management changes as a result of the scintimammography procedure, due to the retrospective nature of their analysis. However, they do believe that the multinational review indicates use of the procedure. “There is evidence that this is a robust imaging technique delivering high sensitivities and specificities in patients studied in both single-center and multicenter trials and, as such, can be relied on as an adjunctive method for the investigation of primary breast cancer,” they wrote. Evidence-based justification for nuclear cardiology procedures also has used the literature meta-analysis approach in lieu of instituting a multisite clinical registry. Myocardial perfusion scintigraphy (MPS) data were presented to the UK National Institute of Clinical Excellence by the British Nuclear Cardiology Society and British Nuclear Medicine Society and discussed in the European Journal of Nuclear Medicine and Molecular Imaging (Feb. 2004). “In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique,” the authors wrote. “MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favorable impact on cost-effectiveness in these groups.” They noted that the technique was being underutilized in the UK, based on wait time for the procedure (20 weeks) and by comparison with the numbers of revascularizations and coronary angiograms performed. The researchers found that the current number of MPS studies performed in the UK was 1,200 per million residents; they estimated that the real need was for 4,000 MPS procedures per million residents. Another study, published in the European Journal of Nuclear Medicine and Molecular Imaging (Jan. 2006) and Journal of Ovarian and abdominal cancers are two of the cancer types for which Medicare currently reimburses only through the National Oncologic PET Registry (NOPR). At left is an ovarian carcinoma in a PET with contrast CT angiography (Biograph 16 PET•CT; courtesy of the University of Tennessee Medical Center, Knoxville). Image at right shows a malignant lymphoma in the abdomen (Biograph 16 PET•CT; courtesy of Beijing Hospital, Beijing, China). a complete list of the covered cancer types for the registry. The study analyzed data regarding nearly 23,000 patients contributed to NOPR by more than 1,200 facilities in the United States that provide PET scans. The mean patient age of the patients was 72.6 years; 9.7 percent were younger than 65 years and 5.2 percent were 85 years or older. The primary end-point of the study was the impact of PET on physicians’ intended management. The study authors assessed a change in management in four ways: › Intended management was stratified as either treatment or nontreatment. › The intent of planned therapies was determined to be either curative or palliative, which allowed the researchers to assess if a meaningful change included a change in intent, even if the specific therapy did not change. › Changes in the type or number of clinical actions were defined as minor or major; a major change was defined as a switch in treatment type and a minor change was defined as the addition or deletion of treatments, but where one type remained constant in the pre- and post-PET plan. › The data also were scored as to whether therapy intensity increased, decreased, or was unchanged by comparing the number of modes in the pre- and post-PET plans. Analysis of data collected found that FDG-PET utilization is associated with a 36.5 percent change in the decision of whether or how to treat a patient’s cancer. The study also found that PET is associated with a management change in almost 75 percent of patients when the addition or deletion to specific modes of therapy was MolecularImaging.net June 2008 | Molecular Imaging Insight http://MolecularImaging.net

Table of Contents Feed for the Digital Edition of Molecular Imaging Insight - June 2008

Molecular Imaging Insight - June 2008 Contents NOPR: A Landmark Study Cover Story: Evidence-based Medicine Points to Wider Role for Molecular Imaging in Patient Care NOPR Delivers Evidence for Expanded PET Use in Oncology Imaging The Balancing Act Nuclear Cardiology’s Next Step Molecular Imaging Training Gaining Traction SPECT/CT’s Role in Post-Transplant Infection Imaging Clinical Study Digest : Heart Disease & Metastatic Breast, Gastric and Head & Neck Cancer

Molecular Imaging Insight - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.