***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : We sought to determine the impact of positron emission tomography/computed tomography ( PET/CT ) on the management of presumed resectable pancreatic cancer and to assess the cost of this new staging procedure . Summary Background Data : PET using 18F-fluorodeoxyglucose ( FDG ) is increasingly used for the staging of pancreatic cancer , but anatomic information is limited . Integrated PET/CT enables optimal anatomic delineation of PET findings and identification of FDG-negative lesions on computed tomography ( CT ) images and might improve preoperative staging . Material and Methods : Patients with suspected pancreatic cancer who had a PET/CT between June 2001 to April 2004 were entered into a prospect i ve data base . Routine staging included abdominal CT , chest x-ray , and CA 19 - 9 measurement . FDG-PET/CT was conducted according to a st and ardized protocol , and findings were confirmed by histology . Cost benefit analysis was performed based on charged cost of PET/CT and pancreatic resection and included the time frame of staging and surgery . Results : Fifty-nine patients with a median age of 61 years ( range , 40–80 years ) were included in this analysis . Fifty-one patients had lesions in the head and 8 in the tail of the pancreas . The positive and negative predictive values for pancreatic cancer were 91 % and 64 % , respectively . PET/CT detected additional distant metastases in 5 and synchronous rectal cancer in 2 patients . PET/CT findings changed the management in 16 % of patients with pancreatic cancer deemed resectable after routine staging ( P = 0.031 ) and was cost saving . Conclusions : PET/CT represents an important staging procedure prior to pancreatic resection for cancer , since it significantly improvespatient selection and is cost-effective BACKGROUND The aim of this work is to assess the diagnostic value of positron emission tomography ( PET ) with 18F-fluorodeoxyglucose ( FDG ) , in the early detection of tumour recurrence in already treated breast cancer patients in apparent complete remission and with a progressive elevation of tumour markers CEA and /or CA 15.3 without any other clinical or instrumental signs of relapses . METHODS The author studied 45 women ( mean age 58+/-12 , range 35 - 80 years ) with histological diagnosis of breast cancer who underwent a tumour marker-guided whole body FDG-PET .  All patients were in remission , without any other clinical or instrumental signs of relapses , except for the progressive elevation of CA 15.3 and /or CEA , tested during the follow-up . FDG-PET results were controlled by pathology when histological sampling was possible , by other conventional imaging modalities ( US , X-rays , CT , MRI ) and /or by clinical follow-up up to 12 months at least . RESULTS FDG-PET findings were evaluated in 38 patients : 27 result ed positive . Among these 27 PET positive patients 24 were true positive and 3 false positive . Tumour marker guided FDG-PET was also able to discover 3 unknown neoplasms not visualized by other modalities . PET revealed 54 sites of intense focal FDG uptake . The anatomical distribution of these sites was 19 skeleton , 18 lymph node basins , 5 liver , 5 pelvic region , 1 lung , 1 pericardium , 1 pleura , 1 contralateral breast , 2 peritoneum and 1 thyroid bed . Forty-eight of these 54 sites of FDG accumulation were confirmed to be metastases . FDG-PET result ed negative in 11 patients and only in 2 of them the other diagnostic modalities were able to discover metastatic lesions ; we had 9 true negative and 2 false positive RESULTS . On the basis of our investigation the performances of tumour marker guided FDG-PET per patient are as follows : sensitivity 92 % ( 24/26 ) , specificity 75 % ( 9/12 ) , positive predictive value 89 % ( 24/27 ) , negative predictive value 82 % ( 9/11 ) , accuracy 87 % ( 33/38 ) . CONCLUSIONS This study demonstrated the clinical utility of tumour marker-guided PET in the follow-up of breast cancer patients . This diagnostic approach allowed to modify the clinical management in those patients in whom a tumor relapse or unexpected primary neoplasm was discovered Abstract Purpose . To determine the sensitivity , specificity and accuracy of magnetic resonance imaging ( MRI ) in detecting breast cancer recurrence . Material s and methods . Forty women conservatively treated for breast cancer underwent MRI and confirmation on histology and cytology of suspected local recurrence . In these patients both clinical and mammographic/ultrasound features of local recurrence were nonspecific or suspicious . All patients were examined at least 1 year after completion of radiation treatment . Dynamic magnetic resonance imaging was performed with a 1.5 T unit using a dedicated bilateral breast coil . Qualitative and quantitative data were obtained . Statistical analysis was also performed with the Student T-test . Results . Breast cancer recurrence was confirmed on histology in 22 patients .  MRI identified all the 22 breast recurrent cancers . False-positive contrast enhancement was seen in only two patients . In four patients recurrence was classified as multifocal . In one patient the tumor was detected in the contralateral breast . MRI showed 95 % accuracy , 100 % sensitivity , 88.8 % specificity with 5 % false-positives and 100 % negative predictive value . Conclusion . Dynamic MRI appears a valuable technique for differentiation of post-treatment changes from recurrent carcinoma and for guiding the histological confirmation . Its high negative predictive value may have an impact on follow-up of treated breast PURPOSE Carcinoembryonic antigen ( CEA ) is still a widely used test for monitoring breast cancer , although recent reports discourage its routine use because of low sensitivity . This is a prospect i ve study evaluating the efficacy of CEA and CA 15.3 in monitoring breast cancer . EXPERIMENTAL DESIGN Serum CEA and CA 15.3 were measured in 2191 patients with either benign ( n = 738 ) or malignant ( n = 1453 ) breast diseases . Five hundred and forty-nine patients were monitored during postsurgical follow-up  for either a minimum of 5 years or until time of recurrence . Fifty-three patients with metastases were also monitored during chemotherapy .  RESULTS Elevated CEA and CA 15.3 levels were found in 16.7 % and 33.0 % of patients , respectively . CEA sensitivity rose to 41.3 % and CA 15.3 sensitivity rose to 80.8 % in metastatic patients . The adjunct of CEA increased the CA 15.3 sensitivity by 6 % in the overall population and by only 2.1 % for patients with metastases . During postsurgical follow-up , CEA was elevated in 38.0 % and CA 15.3 in 70.2 % of patients with recurrence . The combination of CEA and CA 15.3 increased the overall sensitivity by only 1.4 % . Longitudinal monitoring of 53 metastatic patients undergoing chemotherapy demonstrated that , when positive , both CEA and CA 15.3 paralleled response to treatment , although CA 15.3 was a significantly more powerful marker for determining response to treatment . The cost effectiveness ratio of CEA was clearly less favorable than that of CA 15.3 . CONCLUSIONS CEA monitoring should be considered an expensive and inefficient method of follow-up evaluation for breast cancer patients , and it provides no additional value when used in combination with CA 15.3 Abstract Objective : To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D question naire . Design : Stratified r and om sample representative of the general population aged 18 and over and living in the community . Setting : United Kingdom . Subjects : 3395 people resident in the United Kingdom . Main outcome measures : Average values for mobility , self care , usual activities , pain or discomfort , and anxiety or depression . Results : One in three respondents reported problems with pain or discomfort . There were differences in the perception of health according to the respondent 's age , social class , education , housing tenure , economic position , and smoking behaviour . Conclusions : The EQ-5D question naire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population . Key messages Measurement of health outcome requires the observation of states of health Patients ' involvement in recording and assessing their own state of health is a major element in the process of evaluating the impact of health care The EuroQoL EQ-5D question naire highlights variations in states of health which are consistent with previously published results High degrees of pain are reported in the general population . A category for pain is absent and thus undetected in the survey of disability by the Office of Population Censuses and Purpose : To study the role of positron emission tomography 18F-fluorodeoxyglucose ( PET FDG ) imaging in patients with a suspicion of breast cancer recurrence . Procedures : Whole-body PET FDG was performed in 39 women . Thirty-four were included because of asymptomatic tumor marker increase . PET findings were confirmed by oriented imaging or by biopsy . Follow-up data were collected over a period of at least 12 months . Results : PET FDG depicted 37/39 sites in 31/33 patients with recurrence . PET missed one locoregional recurrence and in one patient peritoneal carcinomatosis developed 6 months after a negative PET . False positive PET FDG corresponded to lung infection , degenerative bone disease , and reconstruction artifact . The conventional imaging work-up depicted sites of recurrence in 6/33 patients . Conclusion : Whole-body PET FDG is highly sensitive for the detection of distant breast cancer recurrence . Prospect i ve studies are m and atory to address its potential impact on patient management and survival 
    Output:
    
Clearly , for each additional diagnostic test that is added to PET , the more expensive the package becomes , but also the more effective it becomes in terms of QALYs gained .
Based on the current model and given the limitations that are apparent in terms of limited availability of data , the result of the current analysis suggests that the use of PET/CT in the diagnosis of recurrent breast cancer in every woman suspected of having a recurrence is unlikely to be cost-effective given the current willingness-to-pay thresholds that are accepted in the UK by decision-making bodies such as the National Institute for Health and Clinical Excellence .
Our modelling suggests that conventional work-up could be the most cost-effective diagnostic strategy given current data .