title: Trends in the Use of (18)F-Fluorodeoxyglucose PET Imaging in Surveillance of Non-Small-Cell Lung and Colorectal Cancer.
abstract: OBJECTIVE
  Surveillance PET after curative-intent treatment of non-small-cell lung cancer (NSCLC) or colorectal cancer (CRC) is not clearly supported by available evidence or the Choosing Wisely campaign. However, the frequency of PET imaging during the surveillance period is relatively unknown.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results-Medicare data, 65,748 patients aged 66 years or older who were diagnosed with stage I to IIIA NSCLC or stage I to III CRC from 2001 through 2009 and who underwent surgical resection were identified. Trends in "any PET" or "PET-only" use 6 to 18 months postoperatively were assessed.
  
  
  RESULTS
  Any PET use more than doubled over the study period. Eleven percent of patients with NSCLC and 4% of those with CRC diagnosed in 2001 received any PET, compared with 25% of patients with NSCLC and 13% of those with CRC in 2009 (P < .001 for both). Higher stage disease was correlated with higher PET utilization and faster growth in use over the study period. PET-only use also increased over the study period, especially in higher stage disease. Fewer than 2% of patients diagnosed with stage IIIA NSCLC in 2001 received PET only, compared with 15% of patients diagnosed in 2009 (P = .014). Similarly, 1% of patients diagnosed with stage III CRC in 2001 received PET only, compared with 8% of patients diagnosed in 2009 (P < .001).
  
  
  CONCLUSIONS
  PET utilization during the surveillance period increased between 2001 and 2009. Further research is needed to determine the factors driving use of surveillance PET and to examine relationships between PET and patient outcomes.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: cveenstr@med.umich.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Veenstra
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Anil
authors.initials: A
authors.lastname: Vachani
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Ciunci
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Zafar
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia VA Medical Center, Philadelphia, Pennsylvania; Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: E Carter
authors.initials: EC
authors.lastname: Paulson
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D011159:Population Surveillance; D049268:Positron-Emission Tomography / Q000639:trends*; D019275:Radiopharmaceuticals; D018426:SEER Program; D014481:United States
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Choosing Wisely; FDG-PET; Positron emission tomographic imaging; colorectal cancer; non–small-cell lung cancer; surveillance