Positron emission tomography: establishing priorities for health technology assessment.
Positron emission tomography: establishing priorities for health technology assessment.
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DOI：
10.3310/hta3160
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发表时间：
1999
影响因子：
3.6
通讯作者：
Glenn Robert;Ruairidh Milne
中科院分区：
文献类型：
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作者：
Glenn Robert;Ruairidh Milne
正电子发射断层扫描（PET）是一种昂贵的诊断成像技术。尽管PET的发展历史悠久，但其在常规临床实践中的成本和有效性仍然未知。在PET临床作用不确定的背景下，联合王国卫生技术常设小组要求审查其目前和潜在的作用，以便确定这一领域的研究优先事项。这个为期3个月的项目有两个明确的目标：(1)回顾PET临床应用的知识状况；(2)确定与PET在英国使用相关的关键卫生技术评估（HTA）研究问题。方法进行文献综述，以确定PET临床应用的知识状态，并进行三轮德尔菲研究，以告知与PET在英国使用有关的HTA研究问题。1996年由美国退伍军人健康管理局（VHA）发表的早期系统综述的结果被用作文献综述的起点。通过MEDLINE和Cochrane图书馆数据库检索更新和扩展了VHA综述。德尔菲研究的参与者是通过与英国五名对PET发展感兴趣和意识的个人讨论而选择的。由于他们的建议，最初邀请了43个人参加，其中两人认为自己没有适当的资格。问卷以传真方式发送给所有被邀请的参与者，他们被要求在一周内将填好的表格传真回来。德尔菲研究的内容和结构是根据文献综述的结果来确定的。与会者的答复和评论是本报告的主要资料来源。结果PET在肿瘤、心脏病和神经精神疾病三大类疾病中得到了广泛的应用。在英国评估其潜在的临床作用时，目前有四种PET模式需要考虑：二维或三维的全环PET扫描仪（在五个地点可用）；部分环形旋转PET扫描仪（目前在英国运行）；改进伽玛相机技术的重合成像；以及利用改进的伽玛相机技术对511 keV光子进行高能准直成像。目前，在所有临床适应症中，各种PET模式的成本效益方面缺乏现有证据，而这些临床适应症目前正在提倡这项技术。此外，许多关于PET诊断准确性的现有报告是有限的，因为它们容易产生偏差，并且通常只涉及非常小的患者数量。德尔菲研究的结果表明，NHS的四个最重要的研究重点（按重要性降序排列）是：(1)(a)全环PET的相对成本效益，(b)使用重合成像的伽马相机PET和(c)现有的诊断策略，以确定肺癌手术干预前的分期；(2)部分环PET与全环PET在肿瘤学中的比较(3)(a)全环PET、(b)使用重合成像的伽马相机PET和(c)现有乳腺癌分期和监测治疗反应的诊断策略的相对成本效益；(4) (a)伽马相机PET重合成像和(b) 511 keV准直正电子成像在选择进行血管重建手术的患者时评估心肌活力的相对成本效益。在主要报告中提供了描述每个研究重点的小插图。结论：该项目的研究结果迅速开展，以告知英国HTA研究的优先级，提供了PET在NHS中潜在临床作用的当代概述。需要证据证明使用PET作为诊断
BACKGROUND Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established. OBJECTIVES This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK. METHODS A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report. RESULTS Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report. CONCLUSIONS The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic