PT  - JOURNAL ARTICLE
AU  - Charles Marcus
AU  - Vasavi Paidpally
AU  - Alexander Antoniou
AU  - Atif Zaheer
AU  - Richard L. Wahl
AU  - Rathan M. Subramaniam
TI  - <sup>18</sup>F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management
AID  - 10.2967/jnumed.114.147884
DP  - 2015 Feb 01
TA  - Journal of Nuclear Medicine
PG  - 204--208
VI  - 56
IP  - 2
4099  - http://jnm.snmjournals.org/content/56/2/204.short
4100  - http://jnm.snmjournals.org/content/56/2/204.full
SO  - J Nucl Med2015 Feb 01; 56
AB  - The Centers for Medicare and Medicaid Services recently ruled that only 3 posttherapy follow-up 18F-FDG PET/CT scans are funded for a tumor type per patient and any additional follow-up PET/CT scans will be funded at the discretion of the local Medicare administrator. The purpose of this study was to evaluate the added value of 4 or more follow-up PET/CT scans to clinical assessment and impact on patient management. Methods: This was an institutional review board–approved, retrospective study. A total of 1,171 patients with biopsy-proven lung cancer who had undergone 18F-FDG PET/CT at a single tertiary center from 2001 to 2013 were identified. Among these, 85 patients (7.3%) had undergone 4 or more follow-up PET/CT scans, for a total of 285 fourth and subsequent follow-up PET/CT scans. Median follow-up from the fourth follow-up PET/CT scan was 31.4 mo (range, 0–155.2 mo). The follow-up PET/CT scan results were correlated with clinical assessment and treatment changes. Results: Of the 285 fourth and subsequent follow-up PET/CT scans, 149 (52.28%) were interpreted as positive and 136 (47.7%) as negative for recurrence or metastasis. A total of 47 patients (55.3%) died during the study period. PET/CT identified recurrence or metastasis in 44.3% of scans performed without prior clinical suspicion and ruled out recurrence or metastasis in 24.2% of scans performed with prior clinical suspicion. The PET/CT scan resulted in a treatment change in 28.1% (80/285) of the patients. New treatment was initiated for 20.4% (58/285) of the scans, treatment was changed in 5.6% (16/285), and ongoing treatment was stopped in 2.1% (6/285). Conclusion: The fourth and subsequent 18F-FDG PET/CT scans performed during follow-up after completion of primary treatment added value to clinical assessment and changed management 28.1% of the time.