PET/CT = better cancer patient management

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  Mary C. Tierney, Editorial Director

Believing and proving that an imaging procedure is effective are two different things. It’s all in the evidence—evidence-based medicine, that is. Recently released, evidence-based data show molecular imaging enables better oncology patient management decisions.

Diagnostic findings from PET/CT imaging changed the intended care of more than one in three cancer patients, according to a study of first-year data from the National Oncologic PET Registry (NOPR), published in the Journal of Clinical Oncology in May. The study analyzed data of nearly 23,000 patients contributed to NOPR by more than 1,200 U.S. facilities that provide PET scans. It found that FDG-PET utilization is associated with a 36.5 percent change in the decision of whether or how to treat a patient’s cancer. It also showed that for patients with a pre-PET plan of biopsy, the post-PET plan had a significant impact on care—with patients avoiding biopsy about 75 percent of the time.

NOPR—sponsored by the Academy of Molecular Imaging and managed by the American College of Radiology and the ACR Imaging Network—was initiated in November 2005 in response to the CMS proposal to expand coverage for PET with F18-FDG PET to include cancers and indications not currently eligible for Medicare reimbursement. It created a way for facilities to get paid for PET/CT studies. (The registry is still open, continuing to accept about 200 patients a day.)

NOPR was designed to meet CMS criteria for evidence development; thus, all patients are Medicare beneficiaries. Cancer types that Medicare currently reimburses for only through NOPR include those of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder. The NOPR web site,, has a complete list of its covered cancer types for the registry.

On the basis of these findings, NOPR has formally asked CMS to reconsider its current National Coverage Determination on FDG-PET and requested that it provide Medicare coverage of FDG-PET for diagnosis, staging and restaging across all oncologic indications. CMS is expected to issue a formal response to the NOPR request by October.

Besides having a significant impact on cancer patient management and gaining reimbursement for cancer imaging studies, the NOPR model holds great promise as a structure for future evidence-based molecular imaging indications. This could answer the call of healthcare policy-makers and payors that are increasingly demanding that evidence-based data justify the utilization of imaging procedures.