Coverage Policy Manual - Arkansas Blue Cross and Blue Shield

Coverage Policy Manual
Policy #:	2012024
Category:	Radiology
Initiated:	June 2012
Last Review:	November 2023

PET or PET/CT for Cancers of the Thymus, Heart, and Mediastinum

Description:

Masses in the mediastinum can be neoplasms (i.e., thymomas, lymphomas, thymic carcinomas, thymic carcinoids, thymolipomas, germ cell tumors, lung metastases) or non-neoplastic conditions (i.e., intrathoracic goiter, thymic cysts, lymphangiomas, aortic aneurysms).

CT of the chest is the primary imaging study and MRI may also be used.

Definitions

Screening – testing in the absence of an established or clinically suspected diagnosis

Diagnosis - testing based on a reasonable clinical suspicion of a particular condition or disorder

Diagnostic Workup – initial staging of documented malignancy

Management – testing to direct therapy of an established condition, which may include preoperative or postoperative imaging, or imaging performed to evaluate the response to nonsurgical intervention. In oncologic imaging, management applies to patients with measurable disease and to imaging performed before or after planned treatment intervention, therapy response, restaging or clinically suspected recurrence.

Surveillance – periodic assessment following completion of therapy. In oncologic imaging, surveillance applies to asymptomatic patients in remission and/or without measurable disease

Cannot be performed or is nondiagnostic – applies when the test:

Is positive or indeterminate for clinically significant pathology when the information provided about the abnormality by the test is not sufficient to direct subsequent management
Is negative when the negative likelihood ratio of the test is both insufficient to confidently exclude the absence of suspected disease and unable to direct subsequent management. This typically applies in scenarios with moderate to high clinical pretest probability with negative testing or low pretest probability with clear evidence for net benefit
Has been previously nondiagnostic because of a persistent clinical factor (e.g., body habitus, immobility) that is very likely to make retesting nondiagnostic as well Cannot be performed due to a medical contraindication (e.g., contrast nephrotoxicity, allergy, or in highly radiation sensitive populations such as pediatrics and pregnancy) or reasonable unavailability related to lack of local expertise or service availability

Standard or conventional imaging: Refers to imaging that does not require a PET/CT. Depending on the clinical scenario and individual patient circumstances, this may include computed tomography, magnetic resonance imaging, ultrasound and/or scintigraphy.

Policy/
Coverage:

EFFECTIVE MARCH 13, 2022

Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria

FDG-PET/CT in patients with Cancers of the Thymus, Heart, and Mediastinum meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes and is covered for:

Diagnostic Workup:

Indicated when surgical resection is being considered and metastatic disease has not been detected by CT or MRI

Management:

Indicated in EITHER of the following scenarios:

Radiation planning for definitive treatment
Restaging after induction chemotherapy if patient is a surgical candidate

For all fully insured contracts, all self-funded church-sponsored health plans and all self-funded government-sponsored health plans other than the Arkansas State and Public School Employees program, the Federal Employee Health Benefit Program and Medicare Advantage plans, as required by Act 583 of the Arkansas Legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.

Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria

PET/CT for patients with Cancers of the Thymus, Heart, and Mediastinum does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes and is not covered for any indication or any circumstance other than those listed above including but not limited to:

Surveillance*

For members with contracts without primary coverage criteria, PET/CT for patients with Cancers of the Thymus, Heart, and Mediastinum is considered investigational and is not covered for any indication or any circumstance other than those listed above including but not limited to:

Surveillance*

Investigational services are specific contract exclusions in most member benefit certificates of coverage.

*For all fully insured contracts, all self-funded church-sponsored health plans and all self-funded government-sponsored health plans other than the Arkansas State and Public School Employees program, the Federal Employee Health Benefit Program and Medicare Advantage plans, as required by Act 583 of the Arkansas Legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.

Note: Standard or conventional imaging: Refers to imaging that does not require a PET/CT. Depending on the clinical scenario and individual patient circumstances, this may include computed tomography, magnetic resonance imaging, ultrasound and/or scintigraphy.

Effective Prior to March 13, 2022

Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria

PET/CT meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes in patients with thymoma or thymic carcinoma ;

For initial staging of the disease
For determining the presence of distant metastases when signs or symptoms of metastatic disease are present.

For all fully insured contracts, all self-funded church-sponsored health plans, and all self-funded government-sponsored health plans (e.g., state and public-school employee plans), other than the Federal Employee Health Benefit Program and Medicare Advantage plans, as required by Act 583 of the Arkansas Legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.

Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria

PET or PET/CT for the evaluation of undiagnosed anterior mediastinal tumors does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.

For members with contracts without primary coverage criteria, PET or PET/CT for the evaluation of undiagnosed anterior mediastinal tumors is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.

PET/CT does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for the following:

In lieu of biopsy to establish a diagnosis of cancer;
As a surveillance tool (i.e., routine scanning post treatment in asymptomatic patients);
As monitoring tool post therapy to predict outcome or prognosis

For members with contracts without primary coverage criteria, PET/CT is considered investigational for the following:

In lieu of biopsy to establish a diagnosis of cancer;
As a surveillance tool (i.e., routine scanning post treatment in asymptomatic patients);
As monitoring tool post therapy to predict outcome or prognosis

Investigational services are specific contract exclusions in most member benefit certificates of coverage.

Effective prior to January 2013

PET or PET/CT for the evaluation of undiagnosed anterior mediastinal tumors does not meet member benefit certificate primary coverage criteria based on a lack of current medical literature reporting improved health outcomes with its use.

PET/CT is not covered:

• In lieu of biopsy to establish a diagnosis of cancer (Podoloff, 2009);

• As a surveillance tool (i.e., routine scanning post treatment in asymptomatic patients)

(Podoloff, 2009; NCCN Guidelines, V1.2012);

• As monitoring tool post therapy to predict outcome or prognosis

These non-covered uses of PET and/or PET/CT are considered investigational because they

have not been shown in scientific studies to improve health outcomes, and these uses are

recommended against in scientific reviews.

Rationale:

NCCN Clinical Practice Guidelines in Oncology: Thymomas and Thymic Carcinomas

PET is listed as an option in after CT or MRI of the chest in the initial evaluation of a mediastinal mass and may be useful to determine whether distant metastases are present. Only one reference is cited, a retrospective analysis of 33 patients with thymic epithelial tumors who underwent both integrated PET/CT and enhanced stand-alone CT before initial surgery, chemotherapy or radiotherapy (Sung, 2006). The authors wanted to assess the usefulness of PET/CT for distinguishing thymic epithelial tumors according to the World Health Organization (WHO) classification. Their results suggested that maximum SUVs of thymic carcinoma were significantly higher than those of high-or low-risk thymomas and a higher proportion of thymic carcinoma showed homogenous 18F-FDG uptake. There was no difference in the imaging studies in the detection of extrathoracic organ metastases and detection of hepatic or bony metastases. Of 7 patients with pleural seeding one was missed with CT. Intrathoracic or extrathoracic lymph node metastases were noted in 7 of 16 patients with thymic carcinoma with PET and in 5 patients with stand-alone CT. NCCN Guidelines state the histologic subtype is less important for management than the extent of the resection.

Technology Assessment – Canadian Agency for Drugs and Technologies in Health (Mujoomdar M, 2010)

The April 2010 Canadian Agency for Drugs and Technologies in Health assessment of PET in Oncology does not include an assessment of PET for the evaluation of thymoma or thymic carcinoma.

NCCN Task Force Report (Podoloff, 2009)

PET in the evaluation of thymoma/thymic cancer was not specifically addressed.

The following general statements are made in this article:

• PET is best used as an adjunct in diagnosis and has not been shown to be a sole definitive test.

• PET should not be performed if results are not anticipated to change management.

• PET must not be used in lieu of a biopsy to establish a diagnosis of cancer.

• No patient should be denied potentially curative therapy based on PET or any other imaging findings alone. .

• Patients with stable disease should not undergo therapy based on PET findings alone.

PET as a surveillance tool should only be used in clinical trials.

Expert Panel Review (Fletcher JW, 2008)

The March 2008 “Recommendations on the Use of FDG-PET in Oncology by a number of “experts” from the U.S. and England did not review, or make recommendations for or against, PET for thymoma/thymic carcinoma.

Technology Assessment – Agency for Healthcare Research & Quality (McEwan AJ, 2008)

There is no review of, or recommendation for or against, PET for thymoma/thymic carcinoma.

American College of Radiology Appropriateness Criteria, 2011

There are no appropriateness criteria for PET for thymoma/thymic carcinoma.

National Oncologic PET Registry reports, 2008, 2009

There is no statistical information for or against PET specifically for thymoma/thymic carcinoma.

Literature Review

There is limited information on the use of PET or PET/CT for evaluation of undiagnosed mediastinal tumors. There are reports of recommendations to use PET but they are based on observations in small number of non-randomized patients. Most articles address PET to determine the invasiveness of a mediastinal tumor and compare to subsequent tumor pathology. There are no articles that report improved patient outcomes or changes in the treatment plan as a result of PET imaging.

Kumar, et al, 2009: Twenty-three patients in India who had CT evidence of an anterior mediastinal mass consistent with thymic origin or suspicious for a thymic mass had FDG PET/CT. Thymic carcinomas were large with SUV mean of 7. As a group thymoma had a SUVmean of 2.3 with no significant difference between the SUVmean of high risk and low risk thymoma.

Kubota et al, 1996: PET was performed in 22 patients with primary mediastinal tumors in Japan and then the studies were compared with pathology of the tumors. Increased FDG was observed in nine of ten patients with thymic carcinomas, lymohomas, invasive thymomas, and a case of sarcoidosis. A moderate level of FDG was found in a myeloma, non-invasive thymomas, and a schwannoma, whereas low uptake was observed in a teratoma and various benign cysts. Both thymic cancer and invasive thymoma showed a high FDG uptake.

Luzzi et al, 2009: In our experience (19 patients) a SUV < 5 is associates with low-risk thymoma (LRT) and minimal invasive thymoma (Masaoka stages I-II) and susceptible to upfront surgery. For lesions with an infiltrative aspect on CT scan associated with a higher SUV, > 5, an open biopsy is mandatory to exclude mediastinal lymphoma, or, in case of high-risk thymoma (HRT), consider a neoadjuvant treatment.

Quint, 2006: Thymic lesions including hyperplasia, thymoma, carcinoid, thymic carcinoma, lymphoma, and germ cell tumors, are frequently FDG avid. However, increased thymic uptake may occur in children and young adults without thymic disease, and this is particularly problematic in assessing for lymphomatous involvement of the thymus in patients with a history of lymphoma. Other FDG avid benign entities, such as thymic sarcoidosis, may occasionally be seen. PET is not usually helpful in distinguishing thymic carcinoma from invasive thymoma and thymic hyperplasia since these may also show intense uptake. If distant foci are identified on PET then invasive thymoma or carcinoma is suspected.

El-Bawab et al, 2010: Of 138 patients undergoing thymoma surgery in Saudi Arabia, 1998 – 2007, a retrospective analysis of computerized databases and medical records of 37 consecutive patients who underwent FDG-PET/CT was performed. Recurrence was confirmed via histopathological exam in 17 patients: mediastinal recurrence in 11, pleural dissemination (recurrence in 6. The decision to do FDG PET/CT was based on

1) persistence of MG symptoms;

2) abnormal CT with indicators of recurrence;

3) indeterminate CT;

4) follow-up for an invasive thymoma even with no evidence or recurrence.

For the detection of anterior medial recurrence and pleural dissemination CT had 71% sensitivity of 85% specificity; for FDG PET/CT it was 82% and 95% respectively. The sensitivity of FDG PET/CT when employed for the diagnosis of thymoma recurrence in the anterior mediastinum reached 100% while sensitivity of CT was only 55%. For the finding of pleural dissemination CT was positive in three patients while FDG PET/CT was positive in only one.

Preoperative Treatment of Patients with High-risk Thymomas, NCT00387868: This is an ongoing phase II, multi-institutional trial of neoadjuvant chemoradiation to increase the chance of a complete resection followed by post-operative chemotherapy. This is for patients with locally advanced thymoma, based on radiographic and biopsy criteria. Patients undergo CT and PET prior to, and after, neoadjuvant therapy. Inclusion criteria require a biopsy-proven thymoma or thymic carcinoma. (www.clinicaltrials.gov)

2014 Update

A literature search was conducted through December 2013. The coverage statement has been changed to include a statement addressing for initial staging and determining distant metastases.

Otsuka (2012) published an article that evaluated the utility of FDG-PET in the diagnosis of thymic epithelial tumors. Seven studies were reviewed and the results reported. The data supported the previous reports that FDG-PET may indicate lymph node metastasis and distant metastasis, which are sometimes difficult to detect using other modalities. When lymph node metastasis and/or distant metastasis are suspected in addition to thymic lesions, FDG-PET/CT, which allows for searching of the entire body at once, is useful. The author concluded that FDG-PET/CT is effective for estimating histopathological malignancy and staging in the diagnosis of thymic epithelial tumors and can be an important imaging test with high relevance to the prognosis of a patient.

Benveniste and colleagues (2013) retrospectively reviewed FDG PET-CT scans of 51 consecutive newly diagnosed patients with thymic epithelial malignancy. PET-CT findings documented focal FDG activity: SUVmax, SUVmean, SUVpeak, and total body volumetric standardized uptake value (SUV) measurements. Among the study patients, 37 had thymoma, 12 thymic carcinoma, and 2 thymic carcinoid. Higher focal FDG uptake was seen in patients with type B3 thymoma than in those with type A, AB, B1, or B2 thymoma (p < 0.006). FDG uptake was higher in patients with thymic

carcinoma or carcinoid than in patients with thymoma (p < 0.0003), with more variable associations with volumetric SUV measurements. There was no significant association observed between higher focal FDG uptake and advanced-stage disease in thymoma patients (p > 0.09), although greater FDG-avid tumor volume was significantly associated with advanced disease (p < 0.03). The authors concluded that focal FDG uptake cannot predict advanced thymoma but is helpful in distinguishing thymoma from thymic carcinoma, or the more aggressive thymoma, type B3.

Sung et al. (2006) reported on a study done to assess the usefulness of integrated PET/CT using 18F-FDG for distinguishing thymic epithelial tumors according to the World Health Organization (WHO) classification. Thirty-three patients with thymic epithelial tumors, who underwent both integrated PET/CT and enhanced CT, were included. Discriminant analysis was performed to determine the relative capabilities of integrated PET/CT and enhanced CT findings to differentiate tumor subgroups. The conclusion was that integrated PET/CT was found to be useful for

differentiating subgroups of thymic epithelial tumors and for staging the extent of the disease.

Ongoing Clinical Trials:

There were no trials identified for PET/CT and thymoma or thymic carcinomas on www.clinicaltrials.gov.

NCCN Guidelines v.1.2014: Thymomas and Thymic Carcinomas

Combined PET-CT may be useful for determining whether distant metastases are present. PET-CT provides better correlation with anatomic structures than PET alone.

2015 Update

A literature search conducted through December 2014 did not reveal any new information that would prompt a change in the coverage statement. The key identified literature is summarized below.

Lococo and colleagues investigated the performance of combined (18)F-FDG-PET/CT as a predictor of the WHO-classification based malignancy grade in thymic epithelial tumors (Lococo, 2013). From 05/06 to 02/12, the data of 47 patients with thymic epithelial tumors assessed by (18)F-FDG-PET/CT before being surgically treated were collected in 3 centers and retrospectively reviewed for the purposes of this study. The SUVmax and the SUVmax/T index (the ratio tumor-SUVmax to tumor-size) have been matched with specific subgroups of the WHO-classification: low-risk thymomas (types A-AB-B1), high-risk thymomas (types B2-B3) and thymic carcinomas (type C). There were 22 men and 25 women (age range: 31-84 yrs). Mean tumor size was 44.7 ± 19.0 mm. The WHO-classification was: type-A #2, type-AB #11, type-B1 #9, type-B2 #9, type-B3 #9 and type-C #7. The SUVmax and the SUVmax/T were found to be predictive factors useful to distinguish thymomas from thymic carcinomas (SUVmax: area under ROC-curve: 0.955, p = 0.0045; SUVmax/T-size: area under ROC-curve: 0.927, p = 0.0022). Moreover, both parameters were found to be correlated with the WHO malignancy grade (low-risk thymomas; high-risk thymomas; thymic carcinoma), Spearman correlation coefficients being 0.56 (p < 0.0001) and 0.76 (p < 0.0001), respectively for the SUVmax and for the SUVmax/T index. In addition, the SUVmax is also significantly correlated with Masaoka stage (Spearman correlation coefficient: 0.30, p = 0.0436) CONCLUSIONS: A significant relationship was observed between (18)F-FDG-PET/CT findings and histologic WHO-classification for this cohort of thymic epithelial tumors. Thus, on the basis of these evidences, we infer that (18)F-FDG-PET/CT may be useful to predict histology and the WHO classes of risk.

2017 Update

A literature search conducted through January 2017 did not reveal any new information that would prompt a change in the coverage statement.

2018 Update

A literature search conducted through January 2018 revealed no new information that would prompt a change in the coverage statement.

2018 Update

Annual policy review completed with a literature search using the MEDLINE database through February 2018. No new literature was identified that would prompt a change in the coverage statement.

2019 Update

Annual policy review completed with a literature search using the MEDLINE database through February 2019. No new literature was identified that would prompt a change in the coverage statement.

2020 Update

A literature search was conducted through February 2020. There was no new information identified that would prompt a change in the coverage statement.

2021 Update

Annual policy review completed with a literature search using the MEDLINE database through January 2021. No new literature was identified that would prompt a change in the coverage statement.

November 2021 Update

A literature review was performed through September 2021. Following is a summary of the key literature to date.

DIAGNOSTIC WORKUP

MRI has been shown to be superior to CT for evaluating solitary foci of chest wall invasion, endothoracic fascial involvement, and diaphragmatic muscle invasion. (1) MRI should be considered for suspected chest wall, spinal, diaphragmatic, or vascular involvement based on CT. Although not highly accurate at staging T4 disease or N2 lymphadenopathy, PET plays a role in detection of extra-thoracic disease, eliminating the need for surgery in 16%-40% of patients. (2-6) For thymoma or thymic carcinoma, MRI chest may help differentiate benign cysts and thymoma from thymic carcinoma, thus avoiding the need for surgery. (7, 8) PET can be used for initial staging to differentiate low grade thymoma from FDG-avid thymic carcinoma. (8, 9) In a small number of patients (6%), PET identified unresectable metastatic disease not detected by CT. (9, 10) In a review of 14 studies, PET/CT was able to consistently differentiate benign and malignant disease and detect extrathoracic metastases. Results were mixed regarding correlation with the Masaoka staging system for thymoma, which is based on tumor invasion and metastases. (11)

MANAGEMENT

The American Society for Clinical Oncology recommends CT with assessment of response of malignant pleural mesothelioma based on the RECIST criteria.

SURVEILLANCE

American Society for Clinical Oncology and the National Comprehensive Cancer Network (NCCN) guidelines do not address surveillance imaging for asymptomatic malignant pleural mesothelioma. In most cases, CT should provide adequate information for routine surveillance. Oncologic Imaging guidelines are in concordance with the NCCN Guidelines® for Thymomas and Thymic Carcinomas, NCCN Guidelines® for Malignant Pleural Mesothelioma, and the American Society for Clinical Oncology

guidelines for evaluation of malignant pleural mesothelioma. (12-14)

Current References

Heelan RT, Rusch VW, Begg CB, et al. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol. 1999;172(4):1039-47. PMID: 10587144
Flores RM, Akhurst T, Gonen M, et al. Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2003;126(1):11-6. PMID: 12878934
Sharif S, Zahid I, Routledge T, et al. Does positron emission tomography offer prognostic information in malignant pleural mesothelioma? Interact Cardiovasc Thorac Surg. 2011;12(5):806-11. PMID: 21266493
Sorensen JB, Ravn J, Loft A, et al. Preoperative staging of mesothelioma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography fused imaging and mediastinoscopy compared to pathological findings after extrapleural pneumonectomy. Eur J Cardiothorac Surg. 2008;34(5):1090-6. PMID: 18799318
Wilcox BE, Subramaniam RM, Peller PJ, et al. Utility of integrated computed tomography-positron emission tomography for selection of operable malignant pleural mesothelioma. Clin Lung Cancer. 2009;10(4):244-8. PMID: 19632941
Zahid I, Sharif S, Routledge T, et al. What is the best way to diagnose and stage malignant pleural \=mesothelioma? Interact Cardiovasc Thorac Surg. 2011;12(2):254-9. PMID: 21044972
Abdel Razek AA, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology. 2014;273(1):268-75. PMID: 24877982
Yabuuchi H, Matsuo Y, Abe K, et al. Anterior mediastinal solid tumours in adults: characterisation using dynamic contrast-enhanced MRI, diffusion-weighted MRI, and FDG-PET/CT. Clin Radiol. 2015;70(11):1289-98. PMID: 26272529
Treglia G, Sadeghi R, Giovanella L, et al. Is (18)F-FDG PET useful in predicting the WHO grade of malignancy in thymic epithelial tumors? a meta-analysis. Lung Cancer. 2014;86(1):5-13. PMID: 25175317
Sung YM, Lee KS, Kim BT, et al. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006;47(10):1628-34. PMID: 17015898
Viti A, Terzi A, Bianchi A, et al. Is a positron emission tomography-computed tomography scan useful in the staging of thymic epithelial neoplasms? Interact Cardiovasc Thorac Surg. 2014;19(1):129-34. PMID: 24648467
Kindler HL, Ismaila N, Armato SG, 3rd, et al. Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(13):1343-73. PMID: 29346042
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Malignant Pleural Mesothelioma (Version 2.2021). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2021.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Thymomas and Thymic Carcinomas (Version 1.2021). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2021.

2022 Update

Annual policy review completed with a literature search using the MEDLINE database through September 2022. No new literature was identified that would prompt a change in the coverage statement.

NCCN Guidelines for Thymomas and Thymic Carcinomas (Version 2.2022). were reviewed with no change from 2021 version with regard to PET applications.

2023 Update

Annual policy review completed with a literature search using the MEDLINE database through October 2023. No new literature was identified that would prompt a change in the coverage statement.

CPT/HCPCS:

78811	Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck)
78812	Positron emission tomography (PET) imaging; skull base to mid thigh
78813	Positron emission tomography (PET) imaging; whole body
78814	Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck)
78815	Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid thigh
78816	Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body

References:

American College of Radiology Appropriateness Criteria, Positron emission tomography. http://acsearch.acr.org/Default.aspx

El-Bawab H, Al-Sugair A, et al.(2007) Role of flourine-18 fluorodeoxyglucose positron emission tomography in thymic pathology. Eur J Cardio-thoracic surg, 2007; 31:731-6.

Fletcher JW, Djulbegovic B, et al.(2008) Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med, 2008; 49:480-508.

Hiller BE, Siegel BA, et al.(2008) Impact of Positron Emission Tomography/Computed Tomography and Positron Emission Tomography (PET) alone on expected management of patients with cancer: Initial results from the National Oncologic PET Registry. J Clin Oncol, 2008; 26:2155-61.

Hiller BE, Siegel BA, et al.(2009) The impact of Positron Emission Tomography (PET) on expected management during cancer treatment. Cancer, 2009; 115:410-8.

Kubota K, Yamada S, et al.(1996) PET imaging of primary mediastinal tumours. Br J Cancer, 1996; 73:882-6.

Kumar A, Regmi SK, et al.(2009) Characterization of thymic masses using 18F-FDG PET-CT. Ann Nuc Med, 2009; 23:569-77.

Lococo F, Cesario A, Okami J, et al.(2013) Role of combined 18F-FDG-PET/CT for predicting the WHO malignancy grade of thymic epithelial tumors: a multicenter analysis. Lung Cancer. 2013 Nov;82(2):245-51. doi: 10.1016/j.lungcan.2013.08.003. Epub 2013 Aug 13

Luzzi L, Campione A, et al.(2009) Role of fluorine-flurodeoxyglucose positron emission tomography/computed tomography in preoperative assessment of anterior mediastinal masses. Eur J Cardio-thoracic Surg; 2009; 36:475-9.

McEwan AJ, Gulenchyn K.(2008) Positrom Emission Tomography for nine cancers (bladder, brain, cervical, kidney, ovarian, pancreatic, prostate, small cell lung, testicular). Technology Assessment. http://www.ahrq.gov/browse/techassm.htm .

Mujoomdar M, Moulton K, Nkansah E.(2010) Positron Emission tomography (PET) in Oncology: A systematic review of clinical effectivenss and indications for use. http://www.cadth.ca

National Comprehensive Cancer Network.(2012) NCCN Guidelines. Thymomas and Thymic Carcinomas. www.nccn.org .

National Comprehensive Cancer Network.(2022) 11. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Malignant Pleural Mesothelioma (Version 2.2022). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2022.

National Comprehensive Cancer Network.(2022) 12. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Thymomas and Thymic Carcinomas (Version 2.2022). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2022.

Podoloff DA, Ball DW, et al.(2009) NCCN Task Force Report: Clinical utility of PET in a variety of tumor types; JNCCN, 2009; 7[Supl 2]:S1-23.

Quint LE.(2006) PET: other thoracic malignancies. Cancer Imaging, 2006; 6:S82-8.

Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association.