WASHINGTON—A federal panel has recommended that the Centers for
Medicare and Medicaid Services (CMS) cover the use of positron emission
tomography (PET) as an adjunct to standard staging tests in detecting
locoregional or distant metastases recurrence in some patients when results
from other tests are inconclusive.

In doing so, the executive committee of the CMS Medicare Coverage Advisory
Committee (MCAC) affirmed a series of decisions made by the MCAC’s diagnostic
imaging panel about the use of PET in breast cancer patients. All but one of
the imaging panel’s decisions were negative.

At its June 2001 meeting, the diagnostic imaging panel voted that inadequate
evidence existed for improved health outcomes to support Medicare coverage of
PET in breast cancer in five areas: (1) To decide whether to perform a biopsy
in patients with an abnormal mammogram or palpable mass, (2) to detect breast
cancer in patients with low-suspicion findings on mammography and other routine
imaging procedures, (3) to decide whether to perform axillary node dissection,
(4) to use as a replacement for or adjunct to standard staging tests in looking
for locoregional or distant metastases recurrence, and (5) to evaluate tumor
response to different chemotherapeutic agents.

Two New Studies

The imaging panel’s decision to support PET as an adjunct in patients with
known or suspected recurrent breast cancer hinged on a re-evaluation of the
data. At its meeting, the group received a technology assessment of the
published literature, which found inadequate evidence to support PET for the
diagnosis of recurrent breast cancer.

After an extensive discussion, the panel voted 5 to 0, with one abstention,
to recommend PET coverage for that purpose.

When the executive committee met, Peter Conti, MD, of the University of
Southern California, speaking on behalf of the Society of Nuclear Medicine and
the American College of Radiology, urged ratification of the imaging panel’s
decision on PET.