Quality statement 2: Staging using FDG-PET/CT

Quality statement

Adults with localised pancreatic cancer on CT have staging using fluorodeoxyglucose positron emission tomography/CT (FDG‑PET/CT) before they have surgery, radiotherapy or systemic therapy.

Rationale

Undergoing cancer treatment when the pancreatic cancer has already spread can reduce the person's quality of life without increasing their life expectancy. FDG‑PET/CT adds information to CT imaging and allows for more accurate staging, particularly with respect to detecting metastatic disease. Confirmation of localised disease ensures that treatment continues as planned, but if the cancer has spread, the treatment can be reviewed based on the new information. This can prevent ineffective surgeries or unnecessary radical local treatments.

Quality measures

Structure

Evidence of local arrangements to ensure that FDG‑PET/CT is used for staging in adults with localised pancreatic cancer on CT before they have surgery, radiotherapy or systemic therapy.

Data source: Local data collection, for example service protocols.

Process

Proportion of adults with localised pancreatic cancer on CT having surgery, radiotherapy or systemic therapy who had FDG‑PET/CT before receiving cancer treatment.

Numerator – the number in the denominator who had FDG‑PET/CT staging before receiving treatment.

Denominator – the number of adults with localised pancreatic cancer on CT who had surgery, radiotherapy or systemic therapy.

Data source: Local data collection, for example patient records.

Outcome

a) Proportion of adults with pancreatic cancer who have staging recorded at diagnosis.

Data source:  National Cancer Registration and Analysis Service.

b) Proportion of adults with localised pancreatic cancer on CT who were found to have metastatic disease on FDG‑PET/CT.

Data source:  National Cancer Registration and Analysis Service.

What the quality statement means for different audiences

Service providers (specialist regional centres) have processes in place to ensure that adults with localised pancreatic cancer on CT who will be having cancer treatment (surgery, radiotherapy or systemic therapy) have staging using FDG‑PET/CT before cancer treatment starts to verify that the disease has not spread.

Healthcare professionals (surgeons and oncologists) use FDG‑PET/CT to ensure accurate staging in adults with localised pancreatic cancer on CT before they start cancer treatment (surgery, radiotherapy or systemic therapy).

Commissioners (NHS England and clinical commissioning groups) commission services in which adults with localised pancreatic cancer on CT who will be having cancer treatment (surgery, radiotherapy or systemic therapy) have FDG‑PET/CT to ensure more accurate staging before cancer treatment starts.

Adults with localised pancreatic cancer have a special scan called an FDG‑PET/CT scan. This scan gives doctors information that helps them decide the best treatment. It shows exactly where the cancer is, and how far advanced it is (the stage of the cancer).

Source guidance

Pancreatic cancer in adults: diagnosis and management (2018) NICE guideline NG85, recommendation 1.3.2

Definitions of terms used in this quality statement

Localised pancreatic cancer

Cancer limited to the place where it started, that is, the pancreas, with no sign that it has spread to distant sites.

[Expert opinion]