Article Figures & Data
Figures
- FIGURE 1.
Frequency distribution of post-PET intended management plans among patients scanned for suspected FOM with pre-PET plans of alternative imaging, stratified by cancer type. Seventy-three percent of nonprostate cancer patients and 57% of prostate cancer patients scanned for suspected FOM had pre-PET plans of alternative imaging.
Tables
IS FOM POM Profile Breast NSCLC Other Prostate Breast NSCLC Other Prostate Breast Other Prostate Scans by indication (n) 181 166 223 2,301 781 380 653 4,686 199 236 1,297 Symptoms, signs, or test results (%) None 45.9 30.1 38.1 58.9 10.0 18.9 19.9 16.2 8.5 12.7 10.7 Pain only 36.5 45.8 37.7 5.0 57.0 56.6 49.3 14.6 47.2 52.5 25.9 Elevated or rising tumor marker* 1.7 3.6 1.8 27.2 7.2 2.1 3.8 49.5 10.6 3.8 36.5 Evidence from other imaging 10.5 11.4 9.4 4.5 9.6 10.3 10.1 6.2 6.5 11.9 5.9 Other 5.5 9.0 13.0 4.4 16.3 12.1 16.8 13.6 27.1 19.1 20.9 Pre–NaF PET summary stage (%) Local/no evidence of disease 39.8 12.0 22.0 57.8 28.2 19.5 21.7 24.8 4.5 6.4 5.2 Regional (direct extension or nodal) 14.9 12.7 9.0 5.0 1.9 7.6 3.4 5.0 0.5 1.3 0.8 Single metastasis 5.0 13.3 5.8 3.3 11.1 12.6 10.6 11.2 13.6 12.7 15.2 Multiple metastases 10.5 29.5 24.2 4.6 19.6 30.0 30.5 21.1 74.9 68.2 67.3 Unknown 29.8 32.5 39.0 29.5 39.2 30.3 33.8 37.8 6.5 11.4 11.5 Conventional BS would have been ordered if NaF PET had been unavailable (%) 88.4 78.9 84.3 91.7 82.7 77.6 74.9 85.9 74.9 68.6 87.4 ↵* Abnormal tumor markers including elevated alkaline phosphatase.
NSCLC = non–small cell lung cancer.
IS FOM POM Profile Breast NSCLC Other Prostate Breast NSCLC Other Prostate Breast Other Prostate Scans by indication (n) 181 166 223 2,301 781 380 653 4,686 199 236 1,297 Pre-PET plan (%) Image 50.3 52.4 66.4 52.6 73.2 77.4 70.8 57.1 66.3 72.0 59.5 Body CT 9.4 11.4 16.1 23.6 16.9 18.2 16.5 22.6 17.6 19.9 21.4 Body MR imaging 9.9 10.2 11.7 12.0 13.6 15.0 11.9 16.8 15.6 20.8 18.3 18F-FDG PET 25.4 27.1 32.7 14.0 26.4 29.2 29.9 13.0 25.1 24.6 15.8 Plain films 3.3 2.4 3.1 1.4 12.8 9.2 8.6 2.9 3.5 3.0 1.3 Other imaging 2.2 1.2 2.7 1.7 3.6 5.8 3.8 1.9 4.5 3.8 2.7 Treatment (overall) 39.8 38.0 24.7 39.6 11.0 10.8 15.6 25.6 21.6 17.8 29.6 Radiotherapy 26.0 22.3 9.9 33.1 6.8 5.3 7.7 12.2 10.1 5.9 8.6 Hormone 23.2 1.2 0.4 20.2 4.1 0.3 1.4 16.6 8.0 0.4 18.4 Surgery 27.6 11.4 7.6 12.6 1.4 1.1 2.0 1.8 0.5 0.0 0.3 Chemotherapy 25.4 33.7 20.6 5.1 6.1 8.7 11.3 8.5 14.6 14.4 13.5 Bisphosphonates 1.7 1.2 3.6 3.3 2.8 2.1 2.8 7.1 4.5 5.9 11.5 Biopsy 3.9 3.6 4.0 1.5 4.4 3.7 4.6 3.4 4.0 2.5 1.9 Watch/no additional therapy 6.1 6.0 4.9 6.2 11.4 8.2 9.0 13.8 8.0 7.6 8.9 *Referring physicians could select more than one treatment modality. Percentages do not sum to 100.
NSCLC = non–small cell lung cancer.
IS FOM POM Indication Breast NSCLC Other Prostate Breast NSCLC Other Prostate Breast Other Prostate Scans by indication (n) 181 166 223 2,301 781 380 653 4,686 199 236 1,297 NaF PET findings (%) Benign 72.4 59.6 70.9 71.9 62.1 54.2 57.1 53.3 14.6 18.2 15.0 Equivocal 4.4 7.8 4.9 8.7 7.2 8.9 7.4 7.8 3.0 4.2 2.9 Probable 4.4 9.0 7.6 6.6 6.3 10.3 9.2 10.8 6.5 14.8 6.6 Definite 18.8 23.5 16.6 12.8 24.5 26.6 26.3 28.1 75.9 62.7 75.6 Unifocal 1.1 5.4 3.6 1.7 2.7 3.7 5.4 3.5 4.5 8.5 4.0 Multifocal 9.4 16.3 9.4 8.3 15.4 19.7 16.2 18.8 42.7 44.9 44.7 Diffuse 8.3 1.8 3.6 2.9 6.4 3.2 4.7 5.9 28.6 9.3 26.8 Pre-PET vs. post-PET plans (%) Nontreatment to treatment 66 (36.5) 78 (47.0) 105 (47.1) 956 (41.5) 162 (20.7) 119 (31.3) 171 (26.2) 1,656 (35.3) 110 (55.3) 112 (47.5) 624 (48.1) Nontreatment to nontreatment 43 (23.8) 25 (15.1) 63 (28.3) 433 (18.8) 533 (68.2) 220 (57.9) 380 (58.2) 1,829 (39.0) 46 (23.1) 82 (34.7) 289 (22.3) Treatment to treatment 61 (33.7) 51 (30.7) 44 (19.7) 800 (34.8) 58 (7.4) 23 (6.1) 70 (10.7) 814 (17.4) 33 (16.6) 31 (13.1) 321 (24.7) Treatment to nontreatment 11 (6.1) 12 (7.2) 11 (4.9) 112 (4.9) 28 (3.6) 18 (4.7) 32 (4.9) 387 (8.3) 10 (5.0) 11 (4.7) 63 (4.9) Impact on future actions Avoid future diagnostic tests (%) 81.2 89.8 77.6 72.0 84.4 88.4 84.5 76.5 85.9 89.4 80.9 NSCLC = non–small cell lung cancer.
Data in parentheses are percentages.
- TABLE 4
Change in Intended Management by Indication and Cancer Type with Comparison to Prostate Cancer
Indication Breast NSCLC† Others Prostate‡ P‡ IS Participants (n) 181 166 223 2,301 Change in intended management (%) 42.5 (35.3–49.7) 54.2 (46.6–61.8) 52.0 (45.5–58.6) 46.4 (44.4–48.5) 0.059 Imaging-adjusted frequency of change (%) 11.0 (6.5–15.6) 13.9 (8.6–19.1) 11.2 (7.1–15.4) 10.3 (9.0–11.5) 0.52 Suspected FOM Participants (n) 781 380 653 4686 Change in intended management (%) 24.3*** (21.3–27.3) 36.0** (31.2–40.9) 31.1*** (27.5–34.6) 43.6 (42.2–45.0) <0.0001 Imaging-adjusted frequency of change (%) 7.7*** (5.8–9.5) 8.7** (5.8–11.5) 8.0*** (5.9–10.0) 15.0 (13.9–16.0) <0.0001 Suspected POM Participants (n) 199 – 236 1297 Change in intended management (%) 60.3 (53.5–67.1) – 52.1 (45.7–58.5) 53.0 (50.2–55.7) 0.14 Imaging-adjusted frequency of change (%) 11.6 (7.1–16.0) – 9.3 (5.6–13.0) 10.9 (9.2–12.6) 0.72 ↵† For suspected POM stratum, NSCLC participants were grouped into other cancer type.
↵‡ For each comparison, logistic regression was performed to test difference of rates across specified cancer types on change (or imaging adjusted) in intended management, respectively. Prostate cancer group was used as reference level in regression. P value was calculated using global Wald test.
If global Wald test from logistic regression was significant (P < 0.05), individual tests were performed to find out which cancer types were different from prostate cancer (reference) in terms of change rates. Multiple comparisons were corrected for within this analysis, such that cutoff value for significance level was 0.0167 (0.05/3).
*P value of individual test was smaller than 0.0167.
↵** P value was smaller than 0.01.
↵*** P value was smaller than 0.001.
Data in parentheses are 95% confidence intervals, computed using normal approximation for binomial proportion.
Benign Probable Definitive Finding Breast NSCLC Other Prostate Breast NSCLC Other Prostate Breast NSCLC Other Prostate Scans (n) 485 206 373 2,498 105 73 108 870 191 101 172 1,318 Scans (%) 13.6 5.8 10.5 70.1 9.1 6.3 9.3 75.3 10.7 5.7 9.7 74.0 Post-PET intended management (%) Watch 71.3 58.7 63.0 52.3 30.5 39.7 37.0 23.1 15.2 19.8 16.3 12.1 Biopsy 0.8 0.0 2.7 3.5 12.4 11.0 7.4 4.9 4.2 6.9 7.6 2.4 Image 12.4 11.7 9.1 6.4 23.8 13.7 22.2 15.5 23.0 18.8 11.6 7.0 Any treatment 15.5 29.6 25.2 37.8 33.3 35.6 33.3 56.4 57.6 54.5 64.5 78.5 Treatment modalities* Hormones 8.2 1.9 1.1 24.0 11.4 1.4 0.9 36.6 27.7 0.0 5.8 49.7 Chemotherapy 6.8 24.8 20.6 5.8 13.3 21.9 25.9 12.0 28.3 33.7 39.0 24.7 Radiotherapy 2.7 4.4 3.8 15.0 12.4 15.1 13.0 15.9 19.9 33.7 28.5 19.9 Bisphosphonate 1.2 2.9 1.3 4.3 16.2 12.3 9.3 16.7 27.2 10.9 20.9 29.3 ↵* Referring physicians could select more than one treatment modality.
NSCLC = non–small cell lung cancer.
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