title: Impact on Patient Management of [18F]-Fluorodeoxyglucose-Positron Emission Tomography (PET) Used for Cancer Diagnosis: Analysis of Data From the National Oncologic PET Registry.
abstract: We assessed the impact of [(18)F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) on intended management of patients in the National Oncologic PET Registry (NOPR) for three different diagnostic indications: (a) determining whether a suspicious lesion is cancer (Dx), (b) detecting an unknown primary tumor site when there is confirmed or strongly suspected metastatic disease (cancer of unknown primary origin [CUP]), and (c) detecting a primary tumor site when there is a presumed paraneoplastic syndrome (PNS).
  
  
  
  We reviewed a sample of randomly selected reports of NOPR subjects who underwent PET for Dx and CUP and all reports for PNS to find subjects for analysis. For these studies, we evaluated the impact of PET on referring physicians' intended management, based on their management plans reported before and after PET.
  
  
  
  Intended management was changed more frequently in the CUP group (43.1%) than in the Dx (23.9%) and PNS (25.4%) groups (CUP vs. Dx, p < .0001; PNS vs. Dx, p < .0001; CUP vs. PNS, p < .0002). Referring physicians reported that, in light of PET results, they were able to avoid further testing in approximately three-fourths of patients (71.8%-74.6%). At the time when the post-PET forms were completed, biopsies of suspicious sites had been performed in 21.2%, 32.4%, and 23.2%, respectively, of Dx, CUP, and PNS cases.
  
  
  
  Our analysis of NOPR data shows that PET appears to have a substantial impact on intended management when used for three common diagnostic indications.
  
  
  
  [(18)F]-fluorodeoxyglucose-positron emission tomography appears to have a substantial impact on intended management when used for three targeted diagnostic indications: (a) determining whether a suspicious lesion is cancer, (b) detecting an unknown primary tumor site in a patient with confirmed or strongly suspected metastatic disease, and (c) detecting a primary tumor site in a patient with a presumed paraneoplastic syndrome.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA University of Texas Southwestern Medical Center, Dallas, Texas, USA rathan.subramaniam@utsouthwestern.edu.
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Shields
authors.affiliation: Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Archana
authors.initials: A
authors.lastname: Sachedina
authors.affiliation: Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hanna
authors.affiliation: Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.affiliation: Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography; D012042:Registries; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Cancer diagnosis; Cancer of unknown primary origin; National Oncologic PET Registry; Paraneoplastic syndrome