PET scans can help physicians effectively pinpoint the source of cancer. This is possible because many cancer cells are highly metabolic and therefore synthesize the radioactive glucose (sugar) that is injected in the patient prior to the exam. The areas of high glucose uptake are dramatically displayed in the scan imagery, as opposed to the anatomical imagery of CT or MRI, which cannot detect active, viable tumors.

If cancer is found early, it can often be cured. A PET scan can be used in early diagnosis, assisting physicians in determining the best method for treatment. A whole body PET scan may detect whether cancer is isolated to one specific area or has spread to other organs before a treatment path is determined.

Approximately 1,479,350 new cancer cases were expected to be diagnosed in 2009. According to the American Cancer Society, approximately 562,340 Americans are expected to die of cancer this year, more than 1,500 people per day.

National Oncologic PET Registry (NOPR) Data Confirm FDG-PET Has Major Impact on Management of Cancer Patient Care

Clinicians changed the intended care of more than one in three cancer patients as the result of FDG-PET scan findings, according to a study of data from the National Oncologic PET Registry, published online March 24 in the Journal of Clinical Oncology (JCO).

The study analyzed data regarding nearly 23,000 patients contributed to the NOPR by more than 1200 facilities nationwide providing positron emission tomography (PET) scans.

"The NOPR working group sought to measure the impact of PET findings on patient management in a manner minimally intrusive to care providers.  This was critical for successfully collecting the large amount of data required for a robust analysis,” said Bruce Hillner, M.D., lead author for the study and professor and eminent university scholar in the Department of Internal Medicine at Virginia Commonwealth University.

Sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and the ACR Imaging Network (ACRIN), the NOPR was designed to collect questionnaire data from referring physicians on intended patient management before and after a FDG-PET scan.

The NOPR participating PET facility collects from referring physicians both a pre-PET questionnaire (documenting study indication, cancer type and anticipated stage, and planned management if PET were not available) and one of several post-PET questionnaires that assess the referring physician’s planned management in light of the FDG-PET findings.

Analysis of data collected found that FDG-PET is associated with a 36.5% change in the decision of whether or how to treat a patient’s cancer.  NOPR working group co-chair R. Edward Coleman, MD, professor of radiology and chief of the Division of Nuclear Medicine at Duke University School of Medicine and an AMI founding member, comments, “We were especially surprised by the impact of the PET findings on patients who were originally planned to have a biopsy.  The procedure was avoided in approximately three-quarters of these patients.”

The NOPR was launched in May 2006 in response to the Center for Medicare and Medicaid Services’ (CMS) novel “Coverage with Evidence Development” policy to collect data through a clinical registry to inform the center’s FDG-PET coverage determination decisions for currently non-covered cancer indications.

Cancer types Medicare currently covers for reimbursement only through the NOPR include those of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder.  For a complete list of NOPR covered cancer types and indications, go to www.cancerpetregistry.org.

Oncologist and NOPR working group co-chair, Anthony Shields, MD, professor of medicine and oncology at the Karmanos Cancer Institute at Wayne State University and chair of ACRIN’s Oncology Committee says of the research results, “These results confirm what we suspected from increasing experience with PET.  However, we lacked the significant data required to prove the benefit of PET for many uncovered indications.

It’s very encouraging that oncologists and other clinicians may have access to the valuable information PET affords for ensuring the best patient care.”

NOPR has formally asked CMS to reconsider the current National Coverage decision on FDG-PET to end the data collection requirements for diagnosis, staging and restaging. Medicare will review the published data and determine the next steps related to reimbursement for PET scans now only covered through the NOPR.  Barry Siegel, MD, FACR, professor of radiology and chief of the Division of Nuclear Medicine at the Mallinckrodt Institute of Radiology at Washington University and chair of ACRIN’s PET Imaging Core Laboratory, also serves as an NOPR working group co-chair. "Based on these data, Medicare should strongly consider opening up the coverage to include diagnosis, staging and restaging for all cancers, states Dr Siegel.”

FDG-PET, also called PET imaging or PET scan, is a test that images the function of cells to show differences between healthy tissue and diseased tissue. It uses a small amount of a radioactive chemical which is combined with sugar. This combination is called FDG, so the test is sometimes called an FDG-PET scan. It is used to evaluate various neurological and cardiac disorders, as well as for diagnosing, staging, and monitoring the treatment of many different cancers.

For more information about positron emission tomography (PET), please visit www.radiologyinfo.org.