Lung Cancer |

Trends in Use of PET Imaging in Surveillance of Lung Cancer: Implications of the Choosing Wisely Initiative FREE TO VIEW

Anil Vachani; Christine Ciunci, MD; Christine Veenstra, MD; Hanna Zafar, MD; E. Carter Paulson, MD; Andrew Epstein, PhD
Author and Funding Information

University of Pennsylvania, Philadelphia, PA

Chest. 2015;148(4_MeetingAbstracts):584A. doi:10.1378/chest.2281384
Text Size: A A A
Published online


SESSION TITLE: Lung Cancer Treatment & Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM

PURPOSE: Surveillance positron emission tomography (PET) imaging following curative intent treatment of non-small cell lung cancer (NSCLC) is not supported by available evidence. ASCO and ABIM's joint Choosing Wisely campaign recommends against surveillance PET, yet the frequency with which PET imaging is performed during surveillance care is unknown. We aimed to describe trends in PET use among patients with Stage I-IIIA NSCLC following surgical resection.

METHODS: Patients aged 66+ and diagnosed with stage I-IIIA NSCLC in 2001-2009, who underwent surgical resection were identified in SEER-Medicare data. Eligibility for surveillance started 180 days post-operatively. Use of imaging was assessed during the first year of surveillance and classified as 1) Any-PET: receipt of PET or integrated PET/CT regardless of other imaging, or 2) PET-only: receipt of PET or integrated PET/CT only, in patients who did not undergo separate dedicated chest CT imaging. Proportions of patients receiving each category of PET imaging were adjusted for patient age, sex, race/ethnicity, marital status, Charlson comorbidity index, and ZIP-Code-level median household income in 2000, and then calculated by diagnosis year and stage. Equality of proportions was assessed between diagnosis years with ANOVA tests.

RESULTS: 7,393 NSCLC patients met inclusion criteria. 79% had Stage I NSCLC, 13% Stage II, and 9% Stage IIIA disease. Any-PET use more than doubled over the study period. 11% of all NSCLC patients diagnosed in 2001 received any-PET vs. 25% diagnosed in 2009 (P < 0.001). PET utilization was more common in higher stage NSCLC patients, and increased significantly between 2001 and 2009. In Stage IIIA NSCLC patients diagnosed in 2001, 14% received any-PET compared to 41% diagnosed in 2009 (P = 0.004). PET-only use also increased significantly, more than tripling over the study period. 3% of all NSCLC patients diagnosed in 2001 received PET-only vs. 10% diagnosed in 2009 (P<0.001). Among Stage IIIA patients, 1% diagnosed in 2001 received PET-only, compared to 15% diagnosed in 2009 (P=0.014).

CONCLUSIONS: Although not indicated in surveillance, PET utilization has more than doubled among NSCLC survivors over the study period.

CLINICAL IMPLICATIONS: While surveillance rates may be increasing generally, increased rates of PET-only imaging suggest PET is inappropriately replacing existing surveillance protocols.

DISCLOSURE: Anil Vachani: Grant monies (from industry related sources): Allegro Diagnostics, Grant monies (from industry related sources): Integrated Diagnostics, Grant monies (from industry related sources): Janssen Research & Development, Consultant fee, speaker bureau, advisory committee, etc.: Allegro Diagnostics (SAB) ended Sept 2014 The following authors have nothing to disclose: Christine Ciunci, Christine Veenstra, Hanna Zafar, E. Carter Paulson, Andrew Epstein

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Intermetatarsal neuroma.
Academy of Ambulatory Foot and Ankle Surgery | 1/16/2004
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543