PET scans found to significantly impact treatment decisions made by clinicians

By Sathya Achia Abraham

Clinicians using positron emission tomography scan results in cancer detection changed their treatment decision in more than one third of patient cases, according to a national study led by a Virginia Commonwealth University physician.

The findings, published online today, March 24, in the Journal of Clinical Oncology, suggest the critical importance of positron emission tomography (PET) as a diagnostic technology that has a major impact on management of care in cancer patients.

A PET scan is a relatively new, non-invasive diagnostic technique that creates a three-dimensional map of the body's functional processes. It can be used for detection of many different types of cancers, heart disease, Alzheimer's disease and more.

A specific scan, called the flurodeoxyglucose-PET (FDG-PET), allows clinicians to differentiate between cancerous and normal tissues in the body, identify the location of the disease and if it has spread.

In 2005, PET became among the first technologies to be covered by an insurance policy known as Medicare Coverage with Evidence Development (CED). Prior to this, there was no insurance coverage policy in place for emerging diagnostic and treatment methods such as PET. To help determine coverage requirements involving FDG-PET for previously non-covered cancers, the National Oncologic PET Registry (NOPR) was established to collect relevant data to inform CED.

"The findings from this study will be used in support of a request to the Center of Medicare services to make PET scanning a 'covered' service for all patients with suspected or known cancer independent of the type of cancer," said lead author Bruce Hillner, M.D., professor in the Department of Internal Medicine at the VCU School of Medicine and member scientist with the VCU Massey Cancer Center.

The team reported that on the basis of FDG-PET scan results, clinicians changed their intended course of management in 36.5 percent of cases. Additionally, for patients who were scheduled to undergo biopsy prior to PET, the biopsy was avoided in approximately 70 percent of cases due to results of the scan.

Through the NOPR, Hillner and his colleagues collected data from referring physicians on approximately 23,000 patients at 1,178 medical centers across the United States. The physicians completed a questionnaire regarding intended patient management before PET and after PET.

According to Hillner, the participating physicians were also asked about the number of scans performed for diagnosis of suspected cancer, cancer type and stage and how they planned to manage the case. The post-PET questionnaire examined how the referring physician would approach the case based on the new evidence of the scan.

NOPR is a working group designed to assess how FDG-PET scans affect patient care decisions. It is sponsored by the Academy of Molecular Imaging and managed by the American College of Radiology and the ACR Imaging Network.

This work was supported by a grant from the Academy for Molecular Imaging.

Hillner collaborated with researchers from the Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO; the Center for Statistical Sciences, Brown University, Providence, RI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; American College of Radiology, Philadelphia, PA; and the Department of Radiology, Duke University School of Medicine, Durham, NC.