Research article

Does the availability of positron emission tomography modify diagnostic strategies for solitary pulmonary nodules? An observational study in France

Irawati Lemonnier^1,2 , Cédric Baumann^1,2 , Nicolas Jay^3,4 , Kazem Alzahouri^1,2 , Patrick Arveux⁵ , Damien Jolly^6,7 , Catherine Lejeune⁸ , Michel Velten⁹ , Fabien Vitry⁶ , Marie-Christine Woronoff-Lemsi¹⁰ and Francis Guillemin^1,2

¹Equipe d'Accueil 4003, Nancy-University, Nancy, France

²Institut national de la santé et de la recherche médicale, Centre d'Investigation Cliniques – Epidémiologie Clinique, University Hospital, Nancy, France

³Faculty of Medicine, Nancy-University, Nancy, France

⁴Lorraine Laboratory of Informatics Technology Research and its Applications, Nancy, France

⁵Medical Information Department, Georges-François Leclerc Center, Dijon, France

⁶Clinical research and methodological unit, Maison Blanche Hospital, Reims, France

⁷Equipe d'Accueil 3797, Reims-University, Reims, France

⁸Institut national de la santé et de la recherché médicale, Unité 866, Faculty of Medicine, Dijon University, Dijon, France

⁹Department of Epidemiology and Public Health, Louis Pasteur University and Centre Paul Strauss, Strasbourg, France

¹⁰Medico-economic Evaluation Unit, Pharmacy Service, Besançon University Hospital, Besançon, France

author email corresponding author email

BMC Cancer 2009, 9:139doi:10.1186/1471-2407-9-139

Published:	11 May 2009

Abstract

Background

Previous studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. We aimed to describe the benefits of (PET) in the management of solitary pulmonary nodules (SPNs) in a population level, in terms of the number of diagnostic and invasive tests performed, time to diagnosis and factors determining PET utilization.

Methods

In an observational study, we examined reports of computed tomography (CT) performed and mentioning "spherical lesion", "nodule" or synonymous terms. We found 11,515 reports in a before-PET period, 2002–2003, and 20,075 in an after-PET period, 2004–2005. Patients were followed through their physician, who was responsible for diagnostic management.

Results

We had complete data for 112 patients (73.7%) with new cases of SPN in the before-PET period and 250 (81.4%) in the after-PET period. Patients did not differ in mean age (64.9 vs. 64.8 years). The before-PET patients underwent a mean of 4 tests as compared with 3 tests for the after-PET patients (p = 0.08). Patients in the before-PET period had to wait 41.4 days, on average, before receiving a diagnosis as compared with 24.0 days, on average, for patients in the after-PET period who did not undergo PET (p < 0.001). In the after-PET period, 11% of patients underwent PET during the diagnostic process. A spiculated nodule was more likely to determine prescription for PET (p < 0.001). Multivariate analysis revealed that patients in both periods underwent fewer tests when PET was prescribed by general practitioners (p < 0.001) and if the nodule was not spiculated (p < 0.001). The proportion of unnecessary invasive approaches prescribed (47% vs. 49%) did not differ between the groups.

Conclusion

In our study, 1 year after the availability of PET, the technology was not the first choice for diagnostic management of SPN. Even though we observed a tendency for reduced number of tests and mean time to diagnosis with PET, these phenomena did not fully relate to PET availability in health communities. In addition, the availability of PET in the management of SPN diagnosis did not reduce the overall rate of unnecessary invasive approaches.