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The Impact of PET on the Management of Lung Cancer: The Referring Physician’s Perspective

¹ Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Clinic/Nuclear Medicine, UCLA School of Medicine, Los Angeles, California
² Northern California PET Imaging Center, Sacramento, California

¹⁸F-FDG PET is a molecular whole-body imaging modality that is increasingly being used for diagnosing, staging, and restaging cancer. The objective of this study was to determine referring physicians’ perspectives on the impact of ¹⁸F-FDG PET on staging and management of lung cancer. Methods: A questionnaire was sent to the 292 referring physicians of 744 consecutive patients with known or suspected lung cancer who were evaluated with PET. Questionnaires on 274 patients were returned (response rate, 37%). Management changes were categorized as intermodality (e.g., surgery to medical, surgery to radiation, and medical to no treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach). Results: The primary reasons for PET referral were staging of lung cancer in 61% of patients, diagnosis in 20%, and monitoring of therapy or the course of disease in 6%. Physicians reported that PET caused them to change their decision on clinical stage in 44% of all patients: The disease was upstaged in 29% and downstaged in 15%. PET resulted in intermodality management changes in 39% of patients, whereas 15% had an intramodality change. Conclusion: This survey-based study of referring physicians suggests that PET has a major impact on staging and management of lung cancer.

Key Words: ¹⁸F-FDG PET • lung cancer staging • questionnaire

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