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Study Reinforces Use of PET Scans for Lung Cancer Patients
Dutch researchers found that using PET scans on patients with non-small-cell lung cancer improves the rate of detection of local and distant metastases. Nearly two-thirds of the patients studied had their need for surgery changed due to the results of the PET scan, as opposed to the decision for surgery based on CT results done.
PET-positron emission tomography-is a unique way to view people internally. A PET scan is a noninvasive diagnostic procedure that focuses on the biological difference between normal and cancerous lesions rather than on the anatomical changes provided by a CT scan.
Considerable tumor damage must occur before a CT scan will show anatomical changes. PET scans can reveal a malignancy long before that happens by measuring the increased glucose accumulation in the lesion, allowing physicians a headstart in treatment.
"Pet is not just being used in the pure diagnostic setting, but also in the further areas of how should we treat cancer, is the treatment being effective and is the cancer less active than it was," states Dr. Barbara Croft, Program Director in the biomedical imaging program at the National Cancer Institute. "These are areas that show a great deal of promise for being able to help cancer patients."
Results showed that PET scans correctly spotted 91 percent of tumors that had spread from the lungs to the center of the chest, compared with 75 percent for CT scans.
PET scans were superior to CT scans at establishing that cancer had not spread to the central chest. Results were correctly determined with PET scans in 86 percent of the patients, compared with 66 percent for CT scans. In 11 patients, PET was able to detect distant tumors that CT scans missed.
In addition, 62 patients received different cancer staging information with their PET scans than with their conventional scans. For 20 patients, the lower-stage findings meant they were offered surgery instead of just radiation or chemotherapy; for 42 patients, the higher stage spared them surgeries that would not help.
"This study is consistent with other findings that demonstrate PET’s ability to change patient management," asserts Denise Macias, Alliance Imaging’s National PET Services Director. "Our facilities that use this modality report a different approach to treatment in over half of the cases when a PET scan is incorporated into a patient’s workup."
Medicare began reimbursing for the diagnosis and staging of non-small-cell lung cancer in 1999, along with solitary pulmonary nodules, recurrent colorectal cancer, lymphoma and melanoma. HCFA is currently reviewing additional PET indications for Medicare reimbursement in the areas of oncology, neurology and cardiology and is scheduled to publish their results on December 16, 2000.
According to Wanda Mauk, National Director of Patient Business Services at Alliance Imaging, "We are seeing an increase in the number of insurance plans that include coverage for PET procedures.
The insurance industry is beginning to recognize the significant contribution the PET modality provides the physician in the management of the patient’s treatment plan, as well as providing a potential decrease in the total cost of that treatment."
To receive future PET Medicare reimbursement updates, a reference listing of PET educational articles or to learn more about shared PET service, please e-mail Alliance Imaging at pet@allianceimaging.com
.NOTE: HCFA is currently reviewing the following areas for additional PET indications for Medicare reimbursement:
Oncology - Broad based coverage for the diagnosis, staging and recurrence of all cancers.
Neurology - Dementia workup. Intractable Seizure workup.
Cardiology - Myocardial Viability.
(Alliance Imaging is located at 1065 PacifiCenter Drive, Ste. 200, Anaheim, CA 92806. (800) 544-3215. It is accredited by JCAHO-Joint Commission of Accreditation of Healthcare Organizations.)
The researchers at Netherlands’ Groningen University Hospital studied 102 patients between September 1996 and December 1998 and published their results in The New England Journal of Medicine (2000: 343:254-61).
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