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PET Enhanced CT Scan Performance in Cancer

PET / Enhanced CT Scan Performance in Cancer (Positron Emission Tomography Combined With Computed Tomography or Vascular Contrast CT Scan). COMBI TEP Study

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01881620
Acronym
COMBITEP
Enrollment
109
Registered
2013-06-19
Start date
2010-03-19
Completion date
2015-07-15
Last updated
2024-11-18

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cancer Disease Progression

Keywords

PET scan, CT scan, Diagnostic performance

Brief summary

Hypothesis: The investigators would like to demonstrate that diagnosis performance of PET/CT scan without and with contrast agent (COMBI TEP), are equivalent or better than those of PET/ non enhanced CT scan (PET scan) associated with an enhanced CT scan. This research project is a pilot study given the few available data concerning this imaging exam reproducibility. This study is a prospective single center study.

Detailed description

Hypothesis: We would like to demonstrate that diagnosis performance of PET/CT scan without and with contrast agent (COMBI TEP), are equivalent or better than those of PET/ non enhanced CT scan (PET scan) associated with an enhanced CT scan. This research project is a pilot study given the few available data concerning this imaging exam reproducibility. This study allows us to assess the feasibility of such a large-scale study, but also to evaluate COMBI TEP performance. From these estimates, we can then consider a comparative study to evaluate the performance of COMBI PET. This study is a prospective single center study.

Interventions

DEVICECOMBI TEP : PET / enhanced CT scan

diagnostic imaging exam

Sponsors

Institut Bergonié
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Any patient with a cancerous disease for which PET scan is indicated in the SOR (Standards - Options - Recommendations) FDG PET 2003 updated in 2006 must be included in the trial, in the following locations: 1. Digestive cancers * Colorectal cancer * Preoperative evaluation in local and metastatic recurrence * Location of recurrences, in case of ACE increase in a previously operated patient. * Esophageal cancer: initial staging. * Pancreatic cancer * Initial staging, * Differential diagnosis with chronic pancreatitis. * Liver cancer: differential diagnosis of liver metastases, cholangiocarcinoma and benign tumors in the case of an isolated hepatic localization. * Digestive Endocrine tumors: staging in case of normal pentetreotide scintigraphy. 2. Lung cancer * Initial staging, * Diagnosis of lung isolated lesion \> 1 cm. 3. Head and neck cancer * Initial pretreatment staging, * Recurrence diagnosis 4. Lymphoma * Initial staging of Hodgkin's disease (HD), non-Hodgkin's lymphoma (NHL) and aggressive follicular lymphomas, * Diagnosis of minimal residual disease of HD and aggressive NHL, * Early assessment of treatment response. 5. Thyroid cancer: suspicion of residual disease or relapse when conventional imaging data are insufficient. 6. Ovarian cancer recurrence 7. Age ≥ 18 years. 8. Chest-abdomen-pelvis enhanced CT scan achieved within 4 weeks before enrollment (with cuts of less than 5 mm). 9. Woman of childbearing age with negative pregnancy test and / or contraception. 10. Patient with informed consent signed. 11. Patient affiliated to social security schemes.

Exclusion criteria

1. Iodine known allergy. 2. Diabetes, excepted if controlled (hemoglucotest ≤ 1.6 g). 3. Known renal failure (creatinine clearance \<60ml/min). 4. Indications against Xenetix ®: * Hypersensitivity to Xenetix ® or any of the excipients, * History of an immediate response or delayed cutaneous reaction to Xenetix ® injection. * Thyrotoxicosis. 5. Pregnant or lactating women. 6. Unable to undergo medical follow up for geographical, social or psychological reasons, 7. Private of freedom patient and adult under a legal guardianship or unable to consent.

Design outcomes

Primary

MeasureTime frameDescription
Inter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical Regions1 yearThe primary endpoint was the inter-observer reproducibility of the interpretation of the combined PET / enhanced CT scan (PET-CT) by anatomical region. Reproducibility was assessed for each of the 5 anatomical regions (thorax, abdomen, pelvis, bone, nervous system). Two independant pairs (B1 and B2), each composed of one nuclear physician and one radiologist interpreted the PET-CT examination and described each of the 5 anatomical régions according to 3 modalities (Presence of suspicious lesion(s); Presence of dubious lesion(s); Absence of suspicious and dubious lesion). The inter-observer reproducibility (inter-pairs of observers) was evaluated for each anatomical region by comparing the interpretations of the two pairs, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\].Interpretation by B1 after PET-CT examination (1 month after). Interpretation by B2 at the end of the study

Secondary

MeasureTime frameDescription
Inter-observer (B1 and B2) Reproducibility of the PET-CT at a Patient Level1 yearThe inter-observer reproducibility of combined PET-CT interpretations has been assessed globally for each patient. Same pairs of observer (B1 and B2) than for the primary endpoint evaluation interpreted the PET-CT examination in a global way and concluded for each patient. A weighted Kappa coefficient has been calculated from an identical methodology to that described for the primary endpoint evaluation. Interpretation by B1 was performed at least 1 month and 1 week after PET-CT examination. Interpretation by B2 was performed at the end of the study
Inter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical Regions1 yearFor each of the 5 anatomical régions (thorax, abdomen, pelvis, bone, nervous system), we evaluated the reproducibility between the interpretations of the PET-CT by the nuclear physician alone (N1) and the independent pair (B2) composed by one nuclear physician and one radiologist . The nuclear physician alone (N1) and the independent pair (B2) interpreted the PET-CT examination independently and described each anatomical region.The inter-observer reproducibility has been evaluated for each anatomical region by comparing the interpretations of the nuclear physician alone and that one of independent pair of nuclear physician and radiologist, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\].Interpretation by nuclear physician alone (N1) was performed within 1 week of PET-CT examination. Interpretation by B2 was performed at the end of the study
Inter-observer (N1 and B2) Reproducibility of the PET-CT at a Patient Level1 yearThe inter-observer reproducibility of combined PET-CT interpretations has been assessed globally for each patient. The nuclear physician alone (N1) and the independent pair (B2) interpreted the PET-CT examination independently in a global way and concluded for each patient. The inter-observer reproducibility has been evaluated at patient level by comparing the interpretations of the nuclear physician alone and that one of independent pair of nuclear physician and radiologist, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\]. Interpretation by nuclear physician alone (N1) was performed within 1 week of PET-CT examination. Interpretation by B2 was performed at the end of the study
Intra-observer Reproducibility of Injected CT Scan by Anatomical Regions1 yearFor each anatomical region, the reproducibility of the injected CT scan was evaluated. The same radiologist evaluated the two injected CT scans (CT1 and CT2) and interpreted them (Presence of suspicious lesion(s) OR presence of dubious lesion(s) OR absence of suspicious and dubious lesion). Intra-observer reproducibility was analyzed by using the individual analysis by each radiologist. A weighted Kappa concordance coefficient was calculated per anatomical region using a methodology identical to that described for the evaluation of the proncipal endpoint. Interpretation of CT1 was performed befor inclusion. Interpretation of CT2 was performed at the end of the study.
Intra-observer Reproducibility of Injected CT Scanat a Patient Level1 yearThe reproducibility of the injected CT scan was evaluated globally for each patient. The same radiologist evaluated the two injected CT scans (CT1 and CT2) and interpreted them (Presence of suspicious lesion(s) OR presence of dubious lesion(s) OR absence of suspicious and dubious lesion). Intra-observer reproducibility was analyzed by using the individual analysis by each radiologist. A weighted Kappa concordance coefficient was calculated using a methodology identical to that described for the evaluation of the proncipal endpoint. Interpretation of CT1 was performed befor inclusion. Interpretation of CT2 was performed at the end of the study.

Participant flow

Participants by arm

ArmCount
COMBI TEP : PET / Enhanced CT Scan
COMBI TEP : PET / enhanced CT scan COMBI TEP : PET / enhanced CT scan: diagnostic imaging exam
109
Total109

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyProtocol Violation4

Baseline characteristics

CharacteristicCOMBI TEP : PET / Enhanced CT Scan
Age, Continuous63.6 years
STANDARD_DEVIATION 14.2
height168.4 centimetre
STANDARD_DEVIATION 9.7
Region of Enrollment
France
109 participants
Sex: Female, Male
Female
46 Participants
Sex: Female, Male
Male
63 Participants
Tumor localisation
Digestive
66 Participants
Tumor localisation
Ear Nose and Throat
2 Participants
Tumor localisation
Lung
17 Participants
Tumor localisation
Lymphoma
21 Participants
Tumor localisation
Not available
1 Participants
Tumor localisation
ovarian
1 Participants
Tumor localisation
Thyroid
1 Participants
Weight69.1 kilogram
STANDARD_DEVIATION 15

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
0 / 109
serious
Total, serious adverse events
0 / 109

Outcome results

Primary

Inter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical Regions

The primary endpoint was the inter-observer reproducibility of the interpretation of the combined PET / enhanced CT scan (PET-CT) by anatomical region. Reproducibility was assessed for each of the 5 anatomical regions (thorax, abdomen, pelvis, bone, nervous system). Two independant pairs (B1 and B2), each composed of one nuclear physician and one radiologist interpreted the PET-CT examination and described each of the 5 anatomical régions according to 3 modalities (Presence of suspicious lesion(s); Presence of dubious lesion(s); Absence of suspicious and dubious lesion). The inter-observer reproducibility (inter-pairs of observers) was evaluated for each anatomical region by comparing the interpretations of the two pairs, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\].Interpretation by B1 after PET-CT examination (1 month after). Interpretation by B2 at the end of the study

Time frame: 1 year

Population: Eligible patients with PET-CT scanner performed AND interpretation of 2 pairs of observors available.

ArmMeasureGroupValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical RegionsThorax region0.7254 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical RegionsAbdomen region0.7854 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical RegionsPelvis region0.7597 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical RegionsBone region0.6711 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT by Anatomical RegionsNervous system region1 Weighted kappa concordance coefficient
Secondary

Inter-observer (B1 and B2) Reproducibility of the PET-CT at a Patient Level

The inter-observer reproducibility of combined PET-CT interpretations has been assessed globally for each patient. Same pairs of observer (B1 and B2) than for the primary endpoint evaluation interpreted the PET-CT examination in a global way and concluded for each patient. A weighted Kappa coefficient has been calculated from an identical methodology to that described for the primary endpoint evaluation. Interpretation by B1 was performed at least 1 month and 1 week after PET-CT examination. Interpretation by B2 was performed at the end of the study

Time frame: 1 year

Population: Reproducibility was not calculated for 1 patient because 9 area from thorax region were not assessed by the pair of observer B2.

ArmMeasureValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanInter-observer (B1 and B2) Reproducibility of the PET-CT at a Patient Level0.6528 weighted Kappa coefficient
Secondary

Inter-observer (N1 and B2) Reproducibility of the PET-CT at a Patient Level

The inter-observer reproducibility of combined PET-CT interpretations has been assessed globally for each patient. The nuclear physician alone (N1) and the independent pair (B2) interpreted the PET-CT examination independently in a global way and concluded for each patient. The inter-observer reproducibility has been evaluated at patient level by comparing the interpretations of the nuclear physician alone and that one of independent pair of nuclear physician and radiologist, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\]. Interpretation by nuclear physician alone (N1) was performed within 1 week of PET-CT examination. Interpretation by B2 was performed at the end of the study

Time frame: 1 year

Population: Interpretation by nuclear physician alone was not performed for 1 patient. Interpretation by the pair of observor B2 was incomplete for 1 patient because 9 area from thorax region were not assessed.

ArmMeasureValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT at a Patient Level0.7859 Weighted kappa concordance coefficient
Secondary

Inter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical Regions

For each of the 5 anatomical régions (thorax, abdomen, pelvis, bone, nervous system), we evaluated the reproducibility between the interpretations of the PET-CT by the nuclear physician alone (N1) and the independent pair (B2) composed by one nuclear physician and one radiologist . The nuclear physician alone (N1) and the independent pair (B2) interpreted the PET-CT examination independently and described each anatomical region.The inter-observer reproducibility has been evaluated for each anatomical region by comparing the interpretations of the nuclear physician alone and that one of independent pair of nuclear physician and radiologist, using the weighted kappa concordance coefficient \[ref = Fleiss J, Levin B, Cho Paik M. Statistical methods for rates and proportions. Third ed. 2003.\].Interpretation by nuclear physician alone (N1) was performed within 1 week of PET-CT examination. Interpretation by B2 was performed at the end of the study

Time frame: 1 year

Population: Interpretation by nuclear physician alone was not performed for 1 patient

ArmMeasureGroupValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical RegionsBone region0.8722 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical RegionsThorax region0.8526 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical RegionsAbdomen region0.8153 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical RegionsPelvis region0.7452 Weighted kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanInter-observer (N1 and B2) Reproducibility of the PET-CT by Anatomical RegionsNervous system region1 Weighted kappa concordance coefficient
Secondary

Intra-observer Reproducibility of Injected CT Scanat a Patient Level

The reproducibility of the injected CT scan was evaluated globally for each patient. The same radiologist evaluated the two injected CT scans (CT1 and CT2) and interpreted them (Presence of suspicious lesion(s) OR presence of dubious lesion(s) OR absence of suspicious and dubious lesion). Intra-observer reproducibility was analyzed by using the individual analysis by each radiologist. A weighted Kappa concordance coefficient was calculated using a methodology identical to that described for the evaluation of the proncipal endpoint. Interpretation of CT1 was performed befor inclusion. Interpretation of CT2 was performed at the end of the study.

Time frame: 1 year

ArmMeasureValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scanat a Patient Level0.7984 Weighted Kappa concordance coefficient
Secondary

Intra-observer Reproducibility of Injected CT Scan by Anatomical Regions

For each anatomical region, the reproducibility of the injected CT scan was evaluated. The same radiologist evaluated the two injected CT scans (CT1 and CT2) and interpreted them (Presence of suspicious lesion(s) OR presence of dubious lesion(s) OR absence of suspicious and dubious lesion). Intra-observer reproducibility was analyzed by using the individual analysis by each radiologist. A weighted Kappa concordance coefficient was calculated per anatomical region using a methodology identical to that described for the evaluation of the proncipal endpoint. Interpretation of CT1 was performed befor inclusion. Interpretation of CT2 was performed at the end of the study.

Time frame: 1 year

ArmMeasureGroupValue (NUMBER)
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scan by Anatomical RegionsThorax region0.8141 Weighted Kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scan by Anatomical RegionsAbdomen region0.7991 Weighted Kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scan by Anatomical RegionsPelvis region0.7947 Weighted Kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scan by Anatomical RegionsBone region-0.0095 Weighted Kappa concordance coefficient
COMBI TEP : PET / Enhanced CT ScanIntra-observer Reproducibility of Injected CT Scan by Anatomical RegionsNervous system region1 Weighted Kappa concordance coefficient

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026