The role of PET in staging myeloma not clear. Traditionally, myeloma was staged with IgG levels, bone survey and lab tests. While PET is very sensitive for metastases, it can be falsely positive and is not a good study for nodal staging. Only retrospective analyses are available. However, expert opinion as represented by NCCN does recommend PET as an option for stage I – III disease. For followup surveillance, NCCN added “consider PET” in 2007.
At the same time, another guideline from the same year states: “Based on currently available evidence, neither PET nor MIBI imaging can be recommended for routine use in the management of myeloma patients.
Either technique may be useful in selected cases that warrant clarification of previous imaging findings, but such an approach should ideally be made within the context of a clinical trial (Grade C recommendation; level IV evidence).
The evidence for the sensitivity of PET scanning is most convincing in the setting of extramedullary disease. It is therefore reasonable to consider PET scanning in this setting, to clarify the extent of extramedullary disease, in cases where other imaging techniques have failed to clarify the situation (Grade B recommendation; level III evidence). ” Since NCCN does list it, and NCCN represents expert consensus (as do other guidelines), PET for meyloma cannot be called experimental.
Starting in April 2009, all Medicare beneficiaries with certain cancers will be able to receive Medicare coverage for at least one PET scan, as prescribed by their physicians. The nine currently covered cancers-breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroid-have all been expanded to cover the subsequent treatment strategy, in addition to initial diagnosis. Additionally, Medicare is now expanding coverage to include ovarian cancer and myeloma, making a total of eleven indications now covered for both the initial diagnosis and subsequent treatment strategy for patients. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program, such as a modified NOPR. NCCN in 2010 added PET for staging but not surveillance.
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