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Contrary to available evidence, PET imaging frequently used during NSCLC surveillance
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MONTREAL — Use of PET imaging has more than doubled among survivors of non–small cell lung cancer even though the practice is not supported by available evidence, according to study results presented at the CHEST Annual Meeting.
ASCO and the American Board of Internal Medicine recommend against surveillance PET imaging after curative intent treatment of NSCLC. They made their recommendation as part of their joint Choosing Wisely campaign, which identifies tests, treatments and procedures that are offered unnecessarily. In some cases, the potential harms outweigh the benefits.
Despite the recommendation, the rate at which PET imaging is used during surveillance was unclear, according to study background.
Anil Vachani, MD, associate professor of medicine at Hospital of the University of Pennsylvania, and colleagues conducted a study to assess trends in PET use among patients with stage I to stage IIIA NSCLC who underwent surgical resection.
Vachani and colleagues used the SEER–Medicare database to identify patients aged 66 years and older diagnosed with stage I to stage IIIA NSCLC between 2001 and 2009. Surveillance eligibility began 180 days after resection.
Researchers classified imaging use as any PET — which comprised receipt of Pet or integrated PET/CT regardless of other imaging — or PET only, which comprised receipt of PET or integrated PET/CT only in patients who did not undergo separate chest CT imaging.
Vachani and colleagues identified proportions of patients who received each category of PET imaging. They adjusted for several factors, including patient age, race/ethnicity, sex, Charlson comorbidity index, marital status and zip code-level median household income. They also accounted for diagnosis year and disease stage.
The investigators used ANOVA tests to assess equality of proportions between diagnosis years.
The analysis included 7,393 patients with NSCLC. The majority (79%) had stage I disease, whereas 13% had stage II disease and 9% had stage IIIA disease.
Results showed the rate of any PET use doubled during the study period, increasing from 11% among all patients diagnosed in 2001 to 25% among those diagnosed in 2009 (P < .001).
Patients with higher disease stage appeared more likely to undergo PET. Among those with stage IIIA disease, the rate of any PET imaging increased from 14% among those diagnosed in 2001 to 41% among those diagnosed in 2009 (P = .004).
PET-only use nearly tripled during the study period, increasing from 3% among patients diagnosed in 2001 to 10% among those diagnosed in 2009 (P < .001). The rate of PET-only use among patients with stage IIIA NSCLC increased from 1% among those diagnosed in 2001 to 15% among those diagnosed in 2009 (P = .014).
“Although not indicated in surveillance, PET utilization has more than doubled among NSCLC survivors over the study period,” Vachani and colleagues wrote. “While surveillance rates may be increasing generally, increased rates of PET-only imaging suggest PET is inappropriately replacing existing surveillance protocols.” – by Mark Leiser
Reference:
Vachani A, et al. Abstract #584A. Presented at: CHEST Annual Meeting; Oct. 24-28, 2015; Montreal.
Disclosure: The researchers report grant support from Allegro Diagnostics, Integrated Diagnostics and Janssen; and consultant fees from and speakers bureau/advisory committee roles with Allegro Diagnostics.