Pratiques diagnostiques pour les nodules pulmonaires isolés et le cancer du poumon non à petites cellules : caractérisation, déterminants et évaluation médico-économique de l'introduction de la Tomographie par Emission de Positon

Abstract : We analysed diagnosis practices, medical and economic impact of introducing Positron Emission Tomograghy in the work-up of solitary pulmonary nodule and in mediastinal staging of non small cells lung cancer. First, a literature research was performed to identify studies reporting practice of staging for non selected group of patients with NSCLC. However, lack of detailed reporting limits the interpretation of the results. Based on our review, investigations were conductecl for determining the extent of variation in patterns of physician practices of NSCLC diagnosis and staging. We found that work-up of newly diagnosed solitary pulmonary nodule was found to be an intensive and often protracted process. Physicians differed markedly nn their preferred patterns of SPN management and more than 8 diagnostic pathways were identified. ln 25 % of the patients there was a more than eight-week interval between the first chest CT and a definitive diagnosis concerning the benign or malignant nature of SPN. Second, two clinical decision modelling based on local practice were developed to perform cost effective analysis of PET for diagnosis work-up of SPN and for the mediastinal staging of NSCLC. PET can achieve a cost savings of $1.455 per patient if it is used in combination with CT. The change in life expectancy is 3.1 days (in favour of the PET). in PET has been shown to be cost effective for the staginig of stage I and II breast cancer, recurrent colorectal cancer and non small cell lung cancer. This study demonstrated fhat the installation of a PET facility in France for work-up of SPN and for mediastinal staging of NSCLC is cost effective.
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http://docnum.univ-lorraine.fr/prive/SCD_T_2006_0235_ALZAHOURI.pdf
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Submitted on : Thursday, March 29, 2018 - 10:49:06 AM
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Kazem Alzahouri. Pratiques diagnostiques pour les nodules pulmonaires isolés et le cancer du poumon non à petites cellules : caractérisation, déterminants et évaluation médico-économique de l'introduction de la Tomographie par Emission de Positon. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2006. Français. ⟨NNT : 2006NAN10235⟩. ⟨tel-01746989⟩

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