Utilization of positron emission tomography scans (PET) in the management of NSCLC at a center with limited access to this imaging modality

Abstract

6140 Background: PET is recommended as an important diagnostic aid in the initial evaluation of patients with lung cancer, according to the NCCN guidelines. The aim of this study is to estimate the proportion of NSCLC patients receiving PET, its impact on staging, and its utilization by different treating specialties, in a facility with limited access to PET. This is a situation comparable to several community medical centers. This study was done at the Veterans Hospital, Little Rock (VALR), where the requested PET scans were done at an outside facility, due to its unavailability within this center. Methods: All patients with NSCLC who were diagnosed or treated at VALR between 01/01/03 and 06/30/05 were retrospectively identified from the tumor registry, and details of PET were obtained. Subsequently electronic patient records at VALR were reviewed and the best estimate of pre-PET and post-PET stage was made. The details of the requesting specialty were also obtained. Then frequency distributions relevant to the aims of the study were calculated. Results: 444 patients with diagnosis of NSCLC were identified in this time period, of which 48 (10.8%) had PET scans. Overall 10 (21%) patients were down staged and 4 (8.3%) patients were upstaged. PET helped establish stage among 13 of 15 patients with unknown stage. Details are provided in the table . The number of PET scans requested by treating specialties are as follows: medical oncology 44% (21), pulmonary 40% (19), cardiothoracic surgery 13% (6), and others 3% (2). Conclusions: In this study 10.8% of patients with NSCLC had PET. There was establishment of, or change in stage among 27 (56%) patients. These numbers are comparable to studies from larger centers with ready availability to PET, reflecting its adequate utilization in this setting with limited access. Medical oncology and pulmonary services initiated majority of the PET requests, possibly because of their involvement in the early diagnostic work-up in this patient population. [Table: see text] No significant financial relationships to disclose.