Abstract
The aim was to assess the requirements for a positron emission tomography (PET) cancer imaging service. The UK was used as an example to create a mathematical model for calculating the number of dedicated PET scanners and cyclotron/radiochemistry production facilities required to support the demand for PET studies in lung cancer. This was then extended to all oncological indications for PET and comparison was made with present infrastructure in the UK and Europe. A clinical algorithm for the use of PET in lung cancer management was created and built into a comprehensive computer model with variable parameters. From lung cancer incidences, data reported in the literature and local data, the proportion of patients following each algorithmic path was determined and used to calculate the number of PET scans and hence PET scanners required for lung cancer, and all cancer indications. Substituting lung cancer incidences, the PET infrastructure required for each European country was assessed. From this analysis, 29,886 PET scans per year for lung cancer investigation (provision of 12 scanners) and 121,589 PET scans (2,026.5 per million population) for all indications [provision of 49 scanners (0.82 per million population)] are required in the UK; at present there are seven scanners, and thus 42 new scanners are required. Results reported here demonstrate considerable lack of investment in PET in Europe, with marked variation; Belgium has the most sufficient infrastructure (197.80% of requirements), and excluding France, which is soon to see extensive development, the UK has the least sufficient infrastructure (14.39% of requirements). Considerable investment is required so that cancer management can gain the clinical and cost-effective benefit of this functional imaging technique, which has been established.
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Quinn M, Babb P, Kirby EA, Brock A. Registrations of cancer diagnosed in 1994–1997, England and Wales. Health Statistics Quarterly 07 Autumn, 2000.
ISD Online: http://www.show.scot.nhs.uk/isd/cancer/facts_figures/types/lung.htm.
Cancer incidence data 1993–96 and mortality data 1993–98. Northern Ireland Cancer Registry, 2000.
Maisey MN, Wahl RL, Barrington SF. Atlas of clinical positron emission tomography. London: Arnold; 1999: Chap 5, pp 75–103.
Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999; 49:33–64.
Quinn M, Babb P, Brock A, Kirby L, Jones J. Studies on medical and population subjects No. 66: Cancer trends in England and Wales 1950–1999. National Statistics Publication. The Stationery Office, 2001: Chap 12, pp 84–89.
Kadvi MA, Dussek JE. Survival and prognosis following resection of primary non small cell bronchogenic carcinoma. Eur J Cardiothoracic Surg 1991; 5:132–136.
Hoffman PC, Mauer AM, Vokes EE. Lung cancer. Lancet 2000; 355:479–485.
Cummings SR, Lillington GA, Richard RJ. Estimating the probability of malignancy in solitary pulmonary nodules—a Bayesian approach. Am Rev Respir Dis 1986; 134:449–452.
Ost D, Fein A. Evaluation and management of the solitary pulmonary nodule. Am J Respir Crit Care Med 2000; 162:782–787.
Holin SM, Dwork RE, Glaser S, Rickli AE, Stocklen JB. Solitary pulmonary nodules found in a community-wide chest roentgenographic survey. Radiology 1959; 79:427–439.
Comstock GW, Vaughan RH, Montgomery G. Outcome of solitary pulmonary nodules discovered in an x-ray screening program. N Engl J Med 1956; 254:1018–1022.
Good CA, Wilson TW. The solitary circumscribed pulmonary nodule: study of seven hundred and five cases encountered roentgenographically in a period of three and one-half years. J Am Med Assoc 1958; 166:210–215.
Zerhouni EA, Stitik FP, Siegelman SS. CT of the pulmonary nodule: a cooperative study. Radiology 1986; 160:319–327.
Cummings SR, Lillington GA, Richard RJ. Managing solitary pulmonary nodules. Am Rev Respir Dis 1986; 134:453–460.
Lillington GA. Pulmonary nodules: solitary and multiple. Clin Chest Med 1982; 3:361–367.
Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 1996; 37:943–948.
Ginsberg R, Hill I, Eagan R. Modern 30-day operative mortality for surgical resection in lung cancer. J Thorac Cardiovasc Surg 1983; 86:654–658.
Warburg O, Posener K, Negelein E. The metabolism of the carcinoma cell. In: Warburg O, ed. The metabolism of tumors. New York: Richard R. Smith; 1931:129–169.
Weber G. Enzymology of cancer cells. N Engl J Med 1977; 296:486–492.
Golshani S. Insulin, growth factors, and cancer cell energy metabolism: an hypothesis on oncogene action. Biochem Med Metab Biol 1992; 47:108–115.
Merrall NW, Plevin R, Gould GW. Growth factors, mitogens, oncogenes and the regulation of glucose transport. Cell Signal 1993; 5:667–675.
Yamamoto T, Seino Y, Fukumoto H, Koh G, Yano H, Inagaki N, Yamada Y, Inoue K, Manabe T, Imura H. Over-expression of facilitative glucose transporter genes in human cancer. Biochem Biophys Res Commun 1990; 170:223–230.
Brown RS, Wahl RL. Overexpression of Glut-1 glucose transporter in human breast cancer. An immunohistochemical study. Cancer 1993; 72:2979–2985.
Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? Am J Radiol 1997; 168:325–328.
Warburg O, Wind F, Negleis E. On the metabolism of tumors in the body. In: Warburg O, ed. The metabolism of tumors. London: Constable; 1930:254–270.
Flier JS, Mueckler MM, Usher P, Lodish HF. Elevated levels of glucose transport and transporter messenger RNA are induced by ras or src oncogenes. Science 1987; 235:1492–1495.
Hiraki Y, deHerreros AG, Birnbaum MJ. Transformation stimulates glucose transporter gene expression in the absence of protein kinase C. Proc Natl Acad Sci USA 1989; 86:8252–8256.
Sazon DA, Santiago SM, Soo Hoo GW, et al. Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer. Am J Respir Crit Care Med 1996; 153:417–421.
Shawver LK, Olson SA, White MK, Weber MJ. Degradation and biosynthesis of the glucose transporter protein in chicken embryo fibroblasts transformed by the src oncogene. Mol Cell Biol 1987; 7:2112–2118.
White MK, Weber MJ. Transformation by the src oncogene alters glucose transport into rat and chicken cells by different mechanisms. Mol Cell Biol 1988; 8:138–144.
White MK, Weber MJ. The src oncogene can regulate a human glucose transporter expressed in chicken embryo fibroblasts. Mol Cell Biol 1990; 10:1301–1306.
Brown RS, Leung JY, Kison PV, et al. Glucose transporters and FDG uptake in untreated primary human non-small cell lung cancer. J Nucl Med 1999; 40:556–565.
Smith TA. FDG uptake, tumour characteristics and response to therapy: a review. Nucl Med Commun 1998; 19:97–105.
Haberkorn U, Ziegler SI, Oberdorfer F, et al. FDG uptake, tumor proliferation and expression of glycolysis associated genes in animal tumor models. Nucl Med Biol 1994; 21:827–834.
Gallagher BM, Fowler JS, Gutterson NI. Metabolic trapping as a principle of radiopharmaceutical design: some factors responsible for the biodistribution of [18F]2-deoxy-2-fluoro-d-glucose. J Nucl Med 1978; 19:1154–1161.
Ahmed N, Berridge MV. Regulation of glucose transport by interleukin-3 in growth factor-dependent and oncogene transformed bone marrow-derived cell lines. Leukoc Res 1997; 21:609–618.
Smith TA. Facilitative glucose transporter expression in human cancer tissue. Br J Biomed Sci 1999; 56:285–292.
Mathupala SP, Rempel A, Pedersen PL. Aberrant glycolytic metabolism of cancer cells: a remarkable coordination of genetic, transcriptional, post-translational, and mutational events that lead to a critical role for type II hexokinase. J Bioenerg Biomembr 1997; 29:339–343.
Fukuda H, Matsuzawa T, Abe Y. Experimental study for lung cancer diagnosis with positron-labelled fluorinated glucose analogous. Eur J Nucl Med 1982; 7:294–297.
Dahlbom M, Hoffman EJ, Hoh CK, et al. Evaluation of a positron emission tomography (PET) scanner for whole body imaging. J Nucl Med 1992; 33:1191–1199.
Marom EM, McAdams HP, Erasmus JJ, et al. Staging non-small cell lung cancer with whole-body PET. Radiology 1999; 212:803–809.
Gambhir SS, Shepherd JE, Shah BD, et al. Analytical decision model for the cost-effective management of solitary pulmonary nodules. J Clin Oncol 1998; 16:2113–2125.
Gould M, Sanders G, Barnett P, et al. Cost-effectiveness of positron emission tomography for diagnosis of solitary pulmonary nodules [abstract]. Med Decis Making 2001; 21:528.
Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001; 285:914–924.
Scott WJ, Shepherd J, Gambhir SS. Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: a decision analysis. Ann Thorac Surg 1998; 66:1876–1885.
Gambhir SS, Hoh CK, Phelps ME, Madar I, Maddahi J. Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small cell carcinoma. J Nucl Med 1996; 37:1428–1436.
Dietlein M, Weber K, Gandjour A, et al. Cost-effectiveness of FDG-PET for the management of potentially operable non-small cell lung cancer: priority for a PET-based strategy after nodal-negative CT results. Eur J Nucl Med 2000; 27:1598–1609.
Lewis P, Griffin S, Marsden P, et al. Whole-body18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer. Lancet 1994; 344:1265–1266.
Scott WJ, Schwabe JL, Gupta NC, et al. Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose. The Members of the PET-Lung Tumor Study Group. Ann Thorac Surg 1994; 58:698–703.
Fischer B, Mortensen J, Hojgaard L. Positron emission tomography in the diagnosis and staging of lung cancer: a systematic quantitiative review. Lancet Oncol 2001; 2:659–666.
Vansteenkiste JF, Stroobants SG, De Leyn PR, et al. Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Oncol 1998; 16:2142–2149.
Poncelet AJ, Lonneux M, Coche E, et al. PET-FDG scan enhances but does not replace preoperative surgical staging in non-small cell lung carcinoma. Eur J Cardiothorac Surg 2001; 20:468–474.
Scott WJ, Gobar LS, Terry JD, et al. Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J Thorac Cardiovasc Surg 1996; 111:642–648.
Wahl RL, Quint LE, Greenough RL, et al. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation. Radiology 1994; 191:371–377.
Valk PE, Pounds TR, Hopkins DM, et al. Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. Ann Thorac Surg 1995; 60:1573–1581.
Bury T, Paulus P, Dowlati A, et al. Staging of the mediastinum: value of positron emission tomography imaging in non-small cell lung cancer. Eur Respir J 1996; 9:2560–2564.
Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000; 343:254–261.
Guhlmann A, Storck M, Kotzerke J, et al. Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET). Thorax 1997; 52:438–441.
Chin R Jr, Ward R, Keyes JW, et al. Mediastinal staging of non-small-cell lung cancer with positron emission tomography. Am J Respir Crit Care 1995; 152:2090–2096.
Patz EF Jr, Lowe VJ, Goodman PC, et al. Thoracic nodal staging with PET imaging with 18FDG in patients with bronchogenic carcinoma. Chest 1995; 108:1617–1621.
Inoue T, Kim EE, Komaki R, et al. Detecting recurrent or residual lung cancer with FDG-PET. J Nucl Med 1995; 36:788–793.
Kubota K, Yamada S, Ishiwata K, et al. Positron emission tomography for treatment evaluation and recurrence detection compared with CT in long-term follow-up cases of lung cancer. Clin Nucl Med 1992; 17:877–881.
Patz EF, Jr., Lowe VJ, Hoffman JM, et al. Persistent or recurrent bronchogenic carcinoma: detection with PET and 2-[F-18]-2-deoxy-d-glucose. Radiology 1994; 191:379–382.
Hebert ME, Lowe VJ, Hoffman JM, et al. Positron emission tomography in the pretreatment evaluation and follow-up of non-small cell lung cancer patients treated with radiotherapy: preliminary findings. Am J Clin Oncol 1996; 19:416–421.
Frank A, Lefkowitz D, Jaeger S, et al. Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings. Int J Radiat Oncol Biol Phys 1995; 32:1495–1512.
Bury T, Corhay JL, Duysinx B, et al. Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer. Eur Respir J 1999; 14:1376–1380.
Vanuytsel LJ, Vansteenkiste JF, Stroobants SG, et al. The impact of (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol 2000; 55:317–324.
Kiffer JD, Berlangieri SU, Scott AM, et al. The contribution of18F-fluoro-2-deoxy-glucose positron emission tomographic imaging to radiotherapy planning in lung cancer. Lung Cancer 1998; 19:167–177.
Nestle U, Walter K, Schmidt S, et al.18F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis. Int J Radiat Oncol Biol Phys 1999; 44:593–597.
Abe Y, Matsuzawa T, Fujiwara T, et al. Clinical assessment of therapeutic effects on cancer using18F-2-fluoro-2-deoxy-d-glucose and positron emission tomography: preliminary study of lung cancer. Int J Radiat Oncol Biol Phys 1990; 19:1005–1010.
Dhital K, Saunders CA, Seed PT, et al. [18F]Fluorodeoxyglucose positron emission tomography and its prognostic value in lung cancer. Eur J Cardiothorac Surg 2000; 18:425–428.
Ahuja V, Coleman RE, Herndon J, et al. The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 1998; 83:918–924.
Vansteenkiste JF, Stroobants SG, Dupont PJ, et al. Prognostic importance of the standardized uptake value on18F-fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: an analysis of 125 cases. Leuven Lung Cancer Group. J Clin Oncol 1999; 17:3201–3206.
Laking G, Price P. 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer. Thorax 2001; 56 (Suppl II):ii38–ii44.
Royal College of Physicians of London. Positron emission tomography: a strategy for provision in the UK. Report of the Intercollegiate Standing Committee on Nuclear Medicine: position paper on a strategy for the provision of PET. Royal College of Physicians of London, 2003:www.rcplondon.ac.uk/pubs.
Pauker SG, Kassirer JP. Decision analysis. In: Bailar JC III, Mosteller F, eds. Medical uses of statistics. Boston, MA: NEJM Books; 1992:159–180.
Weinstein M, Fineberg H. Clinical decision analysis. Philadelphia: Saunders, 1980.
Ferlay J, Bray F, Pisani P, Parkin DM. Globocan 2000: cancer incidence, mortality and prevalence worldwide, version 1.0.IARC CancerBase No 5. Lyon: IARC Press, 2001.
Hain SF, Curran KM, Beggs AD, Fogelman I, O’Doherty MJ, Maisey MN. FDG-PET as a “metabolic biopsy” tool in thoracic lesions with indeterminate biopsy. Eur J Nucl Med 2001; 28:1336–1340.
Shon IH, O’Doherty MJ, Maisey MN. Positron emission tomography in lung cancer. Semin Nucl Med 2002; 32:240–271.
Dietlein M, Weber K, Gandjour A, et al. Cost-effectiveness of FDG-PET for the management of solitary pulmonary nodules: a decision analysis based on cost reimbursement in Germany. Eur J Nucl Med 2000; 27:1441–1456.
Shaffer K. Role of radiology for imaging and biopsy of solitary pulmonary nodules. Chest 1999; 116:519S–522S.
Caskey CI, Templeton PA, Zerhouni EA. Current evaluation of the solitary pulmonary nodule. Radiol Clin North Am 1990; 28:511–520.
Winning AJ, McIvor J, Seed WA, et al. Interpretation of negative results in fine needle aspiration of discrete pulmonary lesions. Thorax 1986; 41:875–879.
Gross B, Glazer G, Orringer M, et al. Bronchogenic carcinoma metastatic to normal-sized lymph nodes: frequency and significance. Radiology 1988; 166:71–74.
McLoud TC, Bourgouin PM, Greenberg RW, et al. Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology 1992; 182:319–323.
White P, Adams H, Crane M, et al. Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage tumors? Thorax 1994; 49:951–957.
Primack S, Lee K, Logan P. Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions. Radiology 1994; 193:795–800.
Dillemans B, Deneffe G, Verschakelen J, et al. Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. Eur J Cardiothorac Surg 1994; 8:37–42.
Webb W, Gatsonis C, Zerhouni E, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology 1991; 178:705–713.
Seely JM, Mayo JR, Miller RR, et al. T1 lung cancer:prevalence of mediastinal nodal metastasis and diagnostic accuracy of CT. Radiology 1993; 186:129–132.
Yokoi K, Okuyama A, Mori K. Mediastinal lymph node metastasis from lung cancer: evaluation with201Tl-SPECT; comparison with CT. Radiology 1994; 192:813–817.
O’Doherty MJ. Clinical PET in the UK: dangers of missing an opportunity. Nucl Med Commun 2001; 22:737–739.
O’Doherty MJ, Marsden PK. Being equipped for clinical PET. Lancet 2000; 356:1701–1703.
Kosuda S, Ichihara K, Watanabe M, Kobayashi H, Kusano S. Decision-tree sensitivity analysis for cost-effectiveness of chest 2-fluoro-2-d-[18F] fluorodeoxyglucose positron emission tomography in patients with pulmonary nodules (non-small cell lung carcinoma) in Japan. Chest 2000; 117:346–353.
Laroche C, Wells F, Coulden R, Stewart S, Goddard M, Lowry E, Price A, Gilligan D. Improving resection rate in lung cancer. Thorax 1998; 53:445–449.
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Bedford, M., Maisey, M.N. Requirements for clinical PET: comparisons within Europe. Eur J Nucl Med Mol Imaging 31, 208–221 (2004). https://doi.org/10.1007/s00259-003-1351-6
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DOI: https://doi.org/10.1007/s00259-003-1351-6