Under Medicare's Coverage with Evidence Development policy, PET using 18F-sodium fluoride (NaF PET) to identify osseous metastasis became a covered service if prospective registry data were collected.
The National Oncologic PET Registry (NOPR) developed a NaF PET registry built on the foundation of its prior registry for PET with 18F-FDG. Men with prostate cancer represented 72% of the cases.
METHODS: Prospective data before and after NaF PET were collected from referring and interpreting physicians. The analysis set consisted of consenting men age 65 y or older with prostate cancer undergoing NaF PET for initial staging (IS, n = 1,024), suspected first osseous metastasis (FOM, n = 1,997), or suspected progression of osseous metastasis (POM, n = 510).
RESULTS: Referring physicians indicated that if NaF PET were not available, other advanced imaging (body CT, MR imaging, or 18F-FDG PET) would be their plan in about half of the cases. After NaF PET, the postimaging plan was revised to treatment in 77%, 52%, and 71% for IS, FOM, and POM, respectively. When intended management was classified as either treatment or nontreatment, the overall change in intended management ranged from 44% to 52% and from 12% to 16% if no effect was assumed for those cases with pre-PET plans for other imaging (imaging-adjusted impact). Interpreting physicians recorded definite findings of bone metastasis in 14%, 29%, and 76% for IS, FOM, and POM, respectively. The intended care patterns varied widely across indication and scan abnormality category combinations.
CONCLUSION: NaF PET has high overall impact, principally related to its effect on replacing intended use of other advanced imaging. Its imaging-adjusted impact was similar to that observed with 18F-FDG PET for restaging or suspected recurrence in other cancer types.
Written by:
Hillner BE, Siegel BA, Hanna L, Duan F, Shields AF, Coleman RE. Are you the author?
Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.
Reference: J Nucl Med. 2014 Feb 27. Epub ahead of print.
doi: 10.2967/jnumed.113.130005
PubMed Abstract
PMID: 24578240
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