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The Usefulness of Positron Emission Tomography in Evaluating Patients for Pulmonary Malignancies^*

^* From the Department of Medicine (Drs. McCain, Dunagan, and Chin), Section on Pulmonary and Critical Care Medicine, Wake Forest University Medical School, Winston-Salem, NC; and Department of Cardiothoracic Surgery (Dr. Oaks), Department of Radiology (Ms. Harkness), and Department of Medicine (Dr. Haponik), Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Correspondence to: Trent W. McCain, MD, Pulmonary Fellow, Section on Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1054; e-mail: tmccain{at}wfubmc.edu

Study objective: Positron emission tomography (PET) can contribute to diagnosing and staging lung cancer, but it has not been determined whether this information influences patient care.

Design: We reviewed the effects of thoracic PET scan results during an 11-month period. For each patient, physicians ordering these scans reported how PET specifically altered management, and graded the ease of interpretation and overall usefulness of PET on a 5-point scale. In addition, to appraise general attitudes about PET, we surveyed 488 national American Thoracic Society (ATS) members and 44 physicians at our comprehensive cancer center.

Results: One hundred twenty-six questionnaires regarding patients were mailed to 37 ordering physicians, and 98 responses (78%) were returned, primarily by cardiothoracic surgeons (35%) and pulmonologists (47%). Respondents reported that PET provided new information in 83 patients (85%) and altered patient management in 64 cases (65%). Major effects on management included decisions regarding biopsy (n = 16), surgery (n = 16), and palliative treatment (n = 16). Chest clinicians found PET to be more helpful (4.4 vs 3.9, p = 0.007) and easier to interpret (4.2 vs 3.7, p = 0.025) than other specialists. Among 139 ATS members (28%) responding to the general survey, 51 members (39%) had access to PET. PET was more frequently available to university-based (49%) than community-based (27%) physicians (p = 0.016). The majority of physicians without current access to PET (69%) indicated that they would like to have it available. ATS members with access to PET reported that PET results generally affect decisions regarding biopsy or surgery most often, but found the procedure less helpful than physicians at our center (2.77 vs 3.56, p = 0.003) and ordered it less often for lung cancer staging (60% vs 96%, p = 0.002).

Conclusion: PET scanning is useful in the management of patients with suspected thoracic malignancies, but impressions about its roles vary, with PET regarded more highly where, as at our center, it is used more often. Whether PET alters patient outcomes requires investigation.

Key Words: attitude of health personnel • biopsy, needle • bronchoscopy • carcinoma, non-small cell lung • lung neoplasms • physician’s practice patterns • tomography, emission-computed

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