According to recent research (Zeliadt S et al. Preoperative PET and the reduction of unnecessary surgery among newly diagnosed lung cancer patients in a community setting. J Nucl Med. 2014; 55: 379) 30 percent of surgeries performed for non-small cell lung cancer patients may be unnecessary. Positron emission tomography (PET) was found to reduce unnecessary surgeries by 50 percent. PET imaging prior to surgery helps stage a patient’s disease by providing functional images of tumors and metastases. Preliminary review of the data from this long-term, observational study of an entire community of veterans was inconclusive about the utility of PET, but after a more thorough statistical analysis accounting for selection bias and other confounding factors, the researchers were able to conclude that PET imaging eliminated approximately half of unnecessary surgeries. “It has become standard of care for lung cancer patients to receive preoperative PET imaging,” said Dr Steven Zeliadt, lead author of the study . The prevailing evidence reinforces the general understanding within the medical community that PET is very useful for identifying occult metastases and that it helps get the right people to surgery while avoiding unnecessary surgeries for those who would not benefit.”
For this study, researchers reviewed newly diagnosed non-small lung cancer patients who received preoperative PET to assess the real-life effectiveness of PET as a preventative measure against unnecessarily invasive treatment across a community of patients. A total of 2,977 veterans who underwent PET during disease staging from 1997 to 2009 were included in the study. Of these, 976 patients underwent surgery to resect their lung cancer. During surgery or within 12 months of surgery, 30 percent of these patients were found to have advanced-stage metastatic disease, indicating unnecessary surgery.
Interestingly, the use of PET increased during the study period from 9% to 91%. Conventional multivariate analyses was followed by instrumental variable analyses to account for unobserved anomalies, such as when patients did not undergo PET when it would have been clinically recommended to do so. The new data have the potential to change policy and recommendations regarding the use of oncologic PET for more accurate tumor staging.