Relationship Between Cancer Type and Impact of PET and PET/CT on Intended Management: Findings of the National Oncologic PET Registry

Abstract

We previously reported aggregate data showing that PET was associated with a change in intended management for over one third of patients participating in the National Oncologic PET Registry (NOPR). Here, we present results for specific cancer types and indications for testing. Methods: The NOPR collected questionnaire data from referring physicians on intended management before and after PET. Data were available from 40,863 PET studies done at 1,368 centers. The impact of PET was assessed for 18 cancer types in patients with pathologically confirmed cancer by type and indication for testing (initial staging, restaging, or detection of suspected recurrence), other than treatment monitoring. Results: When intended management was classified as treatment or nontreatment, physicians changed their intended management for 38.0% of cases (95% confidence interval 5 37.6%238.5%). The frequencies of changes in management ranged from 48.7% for myeloma to 31.4% for nonmelanoma skin cancer. Comparisons across testing indications revealed that only in multiple myeloma did PET have a consistently greater impact on intended management. When the intended management plan before PET was treatment, a change in the intent of treatment (curative vs. palliative) or a major change in the modality of treatment occurred at similar frequencies across different cancer types. Conclusion: The impact of PET on physicians' intended management for patients with known cancer was consistent across cancer types.

Impact of18F-Fluoride PET on Intended Management of Patients with Cancers Other Than Prostate Cancer: Results from the National Oncologic PET Registry

“…Overall, the impact of NaF PET on patient management was similar to the impact we have reported on management after 18 F-FDG PET (21,22,24). For each comparison, logistic regression was performed to test difference of rates across specified cancer types on change (or imaging adjusted) in intended management, respectively.…”

“…Chemotherapy (either new or continued) and radiotherapy were slightly more common in each of the nonprostate groups than in prostate cancer. The lower imaging-adjusted impact in FOM in nonprostate cancers (8%) than among prostate cancer and prior reports from our 18 F-FDG PET registry (22,24) are predominantly due to there being fewer eligible patients because about three quarters had pre-PET plans for other imaging.…”

“…Multiple scans from the same patient were assumed to be independent observations. As we have previously reported (19,22,24), to address overestimation of PET's impact by inclusion of cases for which the pre-PET plan was imaging, we computed an imaging-adjusted impact by assuming no change in intended management for all cases for which the initial management plan was alternative imaging. Differences between nonprostate and prostate cancer groups for specific comparisons were assessed for statistical significance with x 2 analyses.…”

“…The NaF PET registry follows the same basic design as the 18 F-FDG PET registry in that data are collected prospectively for each case from the physician requesting NaF PET, from the PET facility, and from the interpreting physician. Detailed descriptions of NOPR operations, human subject protection procedures, and results for 18 F-FDG PET's impact on physicians' intended management were previously reported (21)(22)(23)(24). Patient registration and data are submitted at https://www.cancerpetregistry.org.…”

State-of-the-art SPECT/CT: technology, methodology and applications—defining a new role for an undervalued multimodality imaging technique

“…PET/CT has been shown to increase the average diagnostic accuracy by up to 15 % [1]. It helps avoid biopsies and leads to changes in therapy planning in almost all solid tumour entities [2].…”