Positron Emission Tomography (PET) scans have become increasingly vital in oncology over the last two decades. Initially confined to specialized academic settings, this advanced imaging technology is now widely accessible and plays a central role in diagnosing and managing patients with cancer. The expanded use of PET scans is grounded in solid evidence demonstrating their effectiveness in oncology, supported by organizations like the Centers for Medicare and Medicaid Services (CMS), which has broadened coverage for PET scans based on findings from the National Oncologic PET Registry.
A common misconception surrounding PET scans is their perceived high cost. While often labeled as an “expensive” imaging test, a closer look reveals a more nuanced picture. When considering the cumulative expenses of multiple contrast-enhanced CT scans of the neck, chest, abdomen, and pelvis, the cost of a PET scan can be surprisingly comparable. In many medical facilities, the charges for Magnetic Resonance Imaging (MRI) and PET scans are also quite similar. The decreasing cost of PET scanners and the widespread availability of radiopharmaceuticals like fluorodeoxyglucose (FDG), the primary agent used in PET, have contributed to aligning the overall costs of PET imaging with other advanced imaging techniques.
While concrete data on PET scan costs are essential, understanding their cost-effectiveness is equally crucial. Several peer-reviewed studies have investigated the economic value of PET scans in various clinical scenarios. The well-regarded PLUS trial, conducted in the Netherlands, explored the impact of adding FDG-PET to the standard pre-surgical evaluation of early-stage lung cancer patients. The “conventional workup” in this study represented imaging procedures typically used according to clinical guidelines. The findings revealed that in the group evaluated using conventional methods alone, a significant 41% of thoracotomies (surgical chest incisions) proved to be unnecessary. Conversely, in patients who underwent FDG-PET in addition to the conventional workup, the rate of futile thoracotomies decreased dramatically to just 21%. The researchers concluded that the initial investment in PET imaging was more than offset by the substantial savings achieved by preventing needless surgeries, resulting in an estimated saving of €1,289 per patient.
Further supporting the cost-effectiveness of PET scans, a more recent study focused on patients with advanced gastric cancer reached similar conclusions. In this research, patients with locally advanced gastric cancer underwent FDG-PET/CT scans in conjunction with standard diagnostic procedures, including CT scans, endoscopic ultrasound, and laparoscopy. The PET/CT scans successfully detected previously unsuspected metastatic disease in 10% of patients, identifying spread to areas such as bone, liver, and lymph nodes. By preventing the costs and complications associated with unnecessary surgery, the estimated cost savings per patient amounted to approximately $13,000. Although these studies are compelling, continued research is needed to fully establish the value of PET scans across a broader range of cancers and clinical situations.
Decisions regarding the appropriate use of PET scans in cancer management are continuously being made. While guidelines and policies often present a binary view (covered vs. not covered, recommended vs. not recommended), the reality is that the usefulness of PET scans in specific clinical scenarios exists on a spectrum of probability. For instance, in cases of clinically early-stage breast cancer without any indications of distant spread, the likelihood of a PET scan revealing unexpected disease that would alter treatment is low. However, it’s not zero, as a small percentage of these patients might indeed have undetected metastatic sites that significantly change their management. In contrast, situations like inflammatory breast cancer with palpable axillary lymph nodes carry a higher statistical probability of additional distant disease. Even in high-likelihood scenarios, the certainty of PET scan value never reaches 100%. Coverage decisions and clinical algorithms are based on these probabilities, but they may sometimes limit an oncologist’s ability to make individualized decisions about PET scan utilization based on a complete understanding of the patient’s specific circumstances and all available evidence.
In conclusion, PET scans have proven to be an invaluable asset in the diagnosis, staging, and management of cancer patients. The expanding applications of PET technology have been driven by evidence-based research demonstrating its clinical and economic value. Despite ongoing research to address knowledge gaps, particularly concerning targeted therapies and rare cancers, PET scans have firmly established their worth. In numerous situations, PET scans can contribute to reducing the overall cost of cancer care by preventing unnecessary and ineffective interventions, ultimately improving patient outcomes and resource allocation.
Financial Disclosure: The author has no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article.
References:
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2. Verboom P, van Tinteren H, Hoekstra OS, et al. Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study. Eur J Nucl Med Mol Imaging. 2003;30:1444-9.
3. Smyth E, Schöder H, Strong VE, et al. A prospective evaluation of the utility of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer. Cancer. 2012;118:5481-8.
