Impact on Patient Management of [18F]‐Fluorodeoxyglucose‐Positron Emission Tomography (PET) Used for Cancer Diagnosis: Analysis of Data From the National Oncologic PET Registry

• Published in: The oncologist (Dayton, Ohio) Vol. 21; no. 9; pp. 1079 - 1084
• Main Authors: Subramaniam, Rathan M., Shields, Anthony F., Sachedina, Archana, Hanna, Lucy, Duan, Fenghai, Siegel, Barry A., Hillner, Bruce E.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.09.2016
• Subjects: Aged; Aged, 80 and over; Cancer diagnosis; Cancer Diagnostics and Molecular Pathology; Cancer of unknown primary origin; Female; Fluorodeoxyglucose F18 - therapeutic use; Humans; Male; Middle Aged; National Oncologic PET Registry; Neoplasms - diagnosis; Neoplasms - diagnostic imaging; Neoplasms - epidemiology; Neoplasms, Unknown Primary - diagnosis; Neoplasms, Unknown Primary - diagnostic imaging; Neoplasms, Unknown Primary - pathology; Paraneoplastic syndrome; Paraneoplastic Syndromes - diagnosis; Paraneoplastic Syndromes - diagnostic imaging; Paraneoplastic Syndromes - pathology; Positron-Emission Tomography; Registries; Tomography, X-Ray Computed; Cancer of unknown primary origin; National Oncologic PET Registry; Paraneoplastic syndrome; Cancer diagnosis
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2015-0364

Introduction. We assessed the impact of [18F]‐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). Methods. 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. Results. 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. Conclusion. Our analysis of NOPR data shows that PET appears to have a substantial impact on intended management when used for three common diagnostic indications. Implications for Practice: [18F]‐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. Analysis of reports from the National Oncologic Positron Emission Tomography (PET) Registry (NOPR) indicated that [18F]‐fluorodeoxyglucose‐PET had substantial impact on intended management of patients being assessed for a suspicious lesion or an unknown primary tumor site when there was confirmed or suspected metastasis or when there was presumed paraneoplastic syndrome.