Use of a single visit combined contrast enhanced CT with PET (PET/CeCT) in the staging of oesophageal and gastric cancers during the COVID-19 pandemic – is it adequate, timely and cost effective?

Background COVID-19 has had a massive effect on service provision within the NHS. At our regional oesophagogastric centre the usual protocol for workup of new cancers involves endoscopy, with separate imaging in the form of a contrast enhanced CT, and standard PET/CT (PET with non-contrast CT). To reduce exposure to the hospital environment and potential infection, a group of patients underwent combined PET/CeCT imaging in a single hospital visit. The aim of this project was to assess whether the combined scans were of adequate diagnostic quality, cost efficient, and if they reduced time to treatment. Methods We retrospectively identified all patients who had been discussed in the Upper GI cancer MDT in 2020 at our trust. To be included in the study, the diagnosis must have been made during 2020. Using our MDT records, clinical letters, endoscopy and radiology systems, we obtained dates of investigations along with types and dates of treatment. Data was tabulated in Microsoft Excel. Upper GI consultant radiologists advised on diagnostic quality and technicality of scans, and trust finance directors were able to advise on costs of imaging. Results 211 new oesophageal or gastric cancers were discussed in our MDT in 2020. 33 patients had PET/CeCT, these took place between March and October. 178 patients had separate imaging. Median time from diagnostic OGD to PET/CeCT was 8 days vs 16 days to final imaging in the separate group. Median time from diagnostic OGD to treatment start date was 36 days for PET/CeCT vs 41 days in the separate group. No PET/CeCT’s required repeating due to poor diagnostic quality. At our trust PET/CeCT had a cost saving of £88.58 compared to separate scans. Conclusions Our experience is that PET/CeCT allows accurate radiological staging of oesophagogastric cancers with a single patient visit, at more convenience to the patient and with reduced potential exposure to COVID-19. Patients were able to complete their cancer staging and start their treatment pathway sooner than with separate scans. This comes with a significant cost saving to the NHS per patient, which at our trust scaled up to a potential £18,000 in one year. Our MDT is now planning to perform radiotherapy planning CT images in the same episode.