The value of fourth and subsequent post-treatment 18F-FDG PET/CT scans in the management of patients with non-Hodgkin’s lymphoma

Abstract

Fourth and subsequent follow-up PET/CT scans affect the treatment and management of patients with NHL and add value to clinical assessment and management, especially in patients with a previous clinical suspicion of recurrence.

Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients

“…Although some recent studies have supported the value of follow-up 18 F-FDG PET/CT in different solid tumors, the cost-effectiveness of the routine use of 18 F-FDG PET/CT during the follow-up period as an alternative to the combination of conventional imaging studies has not yet been systematically established (21)(22)(23). Most studies discourage performing routine 18 F-FDG PET/CT scanning as a surveillance imaging modality in asymptomatic oncology patients (10,(23)(24)(25). Therefore, the aim of the present study was to determine different indications of performing follow-up 18 F-FDG PET/CT and its impact on the management of patients with regard to different malignancies.…”

“…Performing routine surveillance 18 F-FDG PET/CT was not cost-effective and had no significant impact on management. The minimal impact on management could be due to lead time bias, and if those patients could get a clinical follow-up, the tumor recurrence would become symptomatic or detected using conventional imaging in several weeks (10,(34)(35)(36).…”

“…The indications were categorized in 4 groups: PET/CT for diagnosis of tumor recurrence (303/1,659, 18.3%), PET/CT before starting therapy for tumor recurrence (64/1,659, 3.9%), PET/CT to assess therapy response for tumor recurrence (507/1,659, 30.6%), and follow-up PET/CT after completion of treatment for tumor recurrence (785/1,659, 47.3%). Overall, fourth and subsequent follow-up 18 F-FDG PET/ CT scans resulted in change in management in 31.6% of the scans (356 of 1,128) when the scans were obtained for medical necessities (indications [1][2][3][4][5][6][7][8][9][10][11], and in 5.6% of the scans (30/531) when the scans were obtained without any medical necessity (indication 12). Conclusion: The fourth and subsequent PET/CT scans obtained after completion of primary treatment led to a change in management in 31.6% of the scans when acquired for appropriate clinical reasons.…”

“…Any additional follow-up 18 F-FDG PET/CT scans (beyond 3) will be covered only at the discretion of local Medicare administrative contractors, justified by a medical necessity (6). Previously, we evaluated the role of fourth and subsequent follow-up 18 F-FDG PET/CT scans obtained after primary treatment completion, in different cancers, and the results showed that 18 F-FDG PET/CT significantly affects the management of these patients especially when there is clinical suspicion of recurrence before performing the scans (7)(8)(9)(10). This study aimed to investigate the common indications of medical necessity to perform a fourth and more follow-up 18 F-FDG PE/CT scans, which may have high impact on the management of patients with different cancers.…”