An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Medicare coverage for positron-emission tomography (PET) with F-18-fluorodeoxyglucose (FDG) in the management of thyroid cancer and soft-tissue sarcoma. In both instances, the Medicare Coverage Advisory Committee (MCAC) concluded that "after an exhaustive review of available literature, we have been unable to make an evidence-based decision." CMS said it would delay any determination "until MCAC has reviewed and made recommendations on reviewing evidence for rare conditions."
In December 2000, CMS (then known as the Health Care Financing Administration) ruled that there was insufficient evidence to support coverage of PET for the management of thyroid cancer. Last year, the American Thyroid Association appealed that decision and submitted new medical data to support the use of PET in the disease. CMS sought an assessment of the data from the Agency for Healthcare Research and Quality (AHRQ), which, the MCAC decided, failed to find sufficient evidence to support coverage. In its assessment, AHRQ stated: "FDG-PET may be helpful in tumor grading, but offers inadequate discrimination between low-grade tumors and benign lesions. There is insufficient data on the impact of FDG-PET on clinical outcomes and on the usefulness of FDG-PET in assessing the response to therapy."
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
