Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Comparative effectiveness of ultrasound (US), conventional computed tomography (CT), multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), fludeoxyglucose positron emission tomography (FDG-PET) or FDG-PET/CT for the primary diagnosis and staging of pancreatic cancer

Which imaging test or test that can “see” some functions of a cancer (e.g. blood flow, consumption of sugar etc) is the best test to diagnose pancreatic cancer and tell how advanced it is or how widely it has spread?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

US, conventional CT, MDCT, MRI, FDG-PET or FDG-PET/CT

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Population at high risk for pancreatic cancer, and patients diagnosed with pancreatic cancer who require staging

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

N/A

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvements in the accuracy of staging among patients with pancreatic cancer, which may assist treatment decisions and prognosis

Describe any health-related risks, side effects, or harms that you are concerned about.

In patients at risk of pancreatic cancer: Harm caused by false positives (such as unnecessary biopsies, increased medical cost, increased stress due to medical diagnoses and treatments), under-diagnosis resulting in failure to achieve early diagnosis and early intervention

In patients diagnosed with pancreatic cancer: Risk of missed metastases diagnosis, errors in pre-therapy staging, errors in staging decisions that may cause unnecessary medical treatments and stress

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Pancreatic cancer is one of the most aggressive malignant tumor types. With less than 5% 5-year survival rate, pancreatic cancer is one of the deadliest cancers. Accurate diagnostic imaging is vital for long-term survival after treatment. Despite great technical advances, detection of pancreatic cancer is unsatisfactory, and new modalities are required.

MRI including diffusion-weighted imaging; anatomic and spatial information provided by CT (MDCT); PET/CT; endoscopic ultrasound, CT and MR for premalignant or non-invasive intraductal neoplasms in high risk individuals.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was recommended by a diverse panel of stakeholders as a high priority question for an evidence review.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Despite great technical advances in the detection of pancreatic cancer, it is unclear how the currently available imaging modalities compare with each other. A formal comparative effectiveness review of these techniques is yet to be performed.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Describe the timeframe in which an answer to your question is needed.

As soon as possible, in order to benefit as many patients as possible

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

The risk of pancreatic cancer affects the general US population, men and women. It includes many individuals representative of both vulnerable populations and those unequally screened for diagnosis.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program