PET/CT without capacity limitations: a Danish experience from a European perspective

OBJECTIVES

We report the 3-year clinical experience of a large new Danish PET/CT centre without capacity limitations in relation to national and European developments.

METHODS

The use of PET/CT in cancer was registered from early 2006 to early 2009 to judge the impact on patient management and to compare it with national and European trends.

RESULTS

6056 PET/CT examinations were performed in 4327 patients. Activity increased by 86 examinations per month compared with the same month the year before. Referrals came primarily from oncology (23.0%), haematology (21.6%), surgery (12.6%), internal medicine (12.7%) and gynaecology (5.5%). Referral indications were diagnosis (31.3%), staging (22.3%), recurrence detection (21.2%), response evaluation (17.0%) and other (8.2%). Response from nearly 60% of users showed that PET/CT caused a change in diagnosis and/or staging and/or treatment plan in 36.0% of cases. During the study period, there was a steep increase in the national use of FDG and in the European use of PET/CT.

CONCLUSIONS

We recorded a constantly increasing use of PET/CT that caused a change in diagnosis and/or staging and/or treatment plan in 36.0% of cases. In line with national and European trends this may suggest a shift in favour of functional rather than anatomical imaging.

PET/CT may change diagnosis and treatment in cancer patients

INTRODUCTION

The national focus on cancer has propelled the use of PET/CT for cancer imaging in Denmark. We believe that first-year experiences from a large PET centre may be of interest to new users.

MATERIAL AND METHODS

Data from all scans made in the period from February 28 2006 to March 1 2007 with a single PET/CT scanner and 18F-fluoro-deoxyglucose (FDG) were collected prospectively along with information on action diagnosis, study purpose, etc. Referring departments indicated if PET/CT had changed or confirmed diagnosis, staging and treatment plan.

RESULTS

A total of 970 scans were made in 826 patients, 14% had 2-5 scans performed. Diagnostic CT was performed in 53%. In all, 792 referrals came from Odense University Hospital. Nearly 85% were from the specialities of oncology (31%), haematology (24%), surgery (14%), internal medicine (9%) and gynaecology (6%). PET/CT for primary diagnosis was mainly used in lung cancer and in cases with unknown primary tumour. In malignant lymphomas and colorectal cancer, the technique was mainly employed for response evaluation. Use of PET/CT for staging and recurrence was more evenly distributed across specialities. PET/CT changed the primary diagnosis in 16% and induced a change in staging and treatment plan in 28% to 32% of cases, respectively.

CONCLUSION

FDG PET/CT was mainly used for diagnosis in lung cancer and in cases with an unknown primary tumour, and for response evaluation in lymphomas and colorectal cancer. PET/CT caused a change of staging and treatment plan in 25-33% of cases.