Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up18F-FDG PET/CT Scans in Oncology Patients.
The Centers for Medicare and Medicaid Services coverage includes 3 posttherapy18F-FDG PET/CT scans per patient and per tumor type. Any additional follow-up18F-FDG PET/CT scans will be reimbursed at the discretion of a local Medicare administrator, if deemed medically necessary. This study aimed to investigate common clinical indications for performing a fourth or additional follow-up18F-FDG PET/CT scans that could affect the management of patients.Methods:This was a retrospective institutional review of 433 oncology patients (203 men; mean age, 55 y), including a total of 1,659 fourth or subsequent follow-up PET/CT scans after completion of primary treatment. Twelve indications for performing a fourth or subsequent follow-up PET/CT scan were determined, and the impact of each of the 12 indications on patients' management was evaluated.Results:The primary tumors were breast cancer (92 patients, 426 scans), non-Hodgkin lymphoma (77 patients, 208 scans), Hodgkin disease (41 patients, 182 scans), colorectal cancer (70 patients, 286 scans), melanoma (69 patients, 271 scans), and lung cancer (84 patients, 286 scans). The indications were categorized in 4 groups: PET/CT for diagnosis of tumor recurrence (303/1,659, 18.3%), PET/CT before starting therapy for tumor recurrence (64/1,659, 3.9%), PET/CT to assess therapy response for tumor recurrence (507/1,659, 30.6%), and follow-up PET/CT after completion of treatment for tumor recurrence (785/1,659, 47.3%). Overall, fourth and subsequent follow-up18F-FDG PET/CT scans resulted in change in management in 31.6% of the scans (356 of 1,128) when the scans were obtained for medical necessities (indications 1-11), and in 5.6% of the scans (30/531) when the scans were obtained without any medical necessity (indication 12).Conclusion:The fourth and subsequent PET/CT scans obtained after completion of primary treatment led to a change in management in 31.6% of the scans when acquired for appropriate clinical reasons. Performing follow-up PET/CT without appropriate medical reason had a low impact on patients' management and should be avoided.
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Mehdi
M
Taghipour
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Charles
C
Marcus
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Sara
S
Sheikhbahaei
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Esther
E
Mena
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Shwetha
S
Prasad
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Abhinav K
AK
Jha
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Lilja
L
Solnes
Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland rathan.subramaniam@UTsouthwestern.edu.|Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.|Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.|Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.|Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, Texas; and.|Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
Rathan M
RM
Subramaniam
D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000379:methods / Q000706:statistics & numerical data*; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
PET/CT; cancer; follow up; management; recurrence