Coverage Policy Manual
Policy #: 2013008
Category: Radiology
Initiated: February 2013
Last Review: December 2021
  PET or PET/CT for Soft Tissue Sarcoma, including Gastrointestinal Stromal Tumor (GIST)

Description:
Positron Emission Tomography (PET) imaging uses radiotracers that can reveal both anatomical and physiological information.  The glucose analog, 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) is useful in cancer imaging because it has been found that tumor cells show increased utilization of glucose compared to non-malignant tissue and is the most common radiotracer that is utilized. For certain malignancies PET scans have been shown to be more accurate than other non-invasive tests in detecting malignant disease.  However, as with all diagnostic tests, PET scans do not detect cancer 100% of the time that cancer is present (a false negative test), nor do all positive PET scans represent the presence of malignant disease (a false positive test).  A false negative test may occur because a critical volume of malignant cells is necessary for a PET scan to be positive. PET scans may be false positive in the presence of inflammation or granulomatous disease.
 
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
 
Soft Tissue Sarcoma
(Includes head/neck, extremity/body wall, retroperitoneal or intra-abdominal sites, and desmoid tumors)
 
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
FDG-PET/CT for patients with Soft Tissue Sarcoma 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 in ANY of the following scenarios (excluding desmoid tumors):
· Standard imaging cannot be performed or is nondiagnostic for metastatic disease
· Standard imaging suggests a resectable solitary metastasis
· Baseline study prior to neoadjuvant chemotherapy
· Initial staging for Rhabdomyosarcoma
Management:
Indicated following completion of neoadjuvant chemotherapy
 
For fully-insured contracts subject to Act 583 of 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 Soft Tissue Sarcoma 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:
· Surveillance*
 
For contracts without primary coverage criteria, PET/CT for patients with Soft Tissue Sarcoma 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 fully-insured contracts subject to Act 583 of Arkansas legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.
 
 
Gastrointestinal Stromal Tumors (GIST)
 
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
FDG-PET/CT for patients with Gastrointestinal Stromal Tumors (GIST) meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for:  
Diagnostic Workup:
Indicated in ANY of the following scenarios:
· Standard imaging cannot be performed or is nondiagnostic for metastatic disease
· Standard imaging suggests a resectable solitary metastasis
· Baseline study prior to neoadjuvant chemotherapy
Management:
Indicated in EITHER of the following scenarios:
· Assess treatment response following completion of neoadjuvant chemotherapy
· Standard imaging cannot be performed or is nondiagnostic for recurrent or progressive disease
 
For fully-insured contracts subject to Act 583 of 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
 
FDG-PET/CT for patients with Gastrointestinal Stromal Tumors (GIST) does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for:
· Surveillance*
 
For contracts without primary coverage criteria, PET/CT for patients with Gastrointestinal Stromal Tumors (GIST) 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 fully-insured contracts subject to Act 583 of 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
 
Soft Tissue Sarcoma of the Extremity, Superficial Trunk, Head, and Neck
 
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
 
FDG-PET/CT meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for patients with Soft Tissue Sarcoma of the extremity, superficial trunk, head, and neck:
 
Diagnostic Workup:  
Indicated in ANY of the following scenarios (all tumor types):  
    • Standard imaging cannot be performed or is nondiagnostic for metastatic disease; OR
    • Standard imaging suggests a resectable solitary metastasis; OR
    • Baseline study prior to neoadjuvant chemotherapy.
 
Treatment Management:  
    • Indicated following completion of neoadjuvant chemotherapy.
 
For fully-insured contracts subject to Act 583 of Arkansas legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.  (Effective August 1, 2021)
 
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
PET/CT for patients with Soft Tissue Sarcoma of the extremity, superficial trunk, head, and neck does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes:
    • For screening and surveillance*; OR
    • For any other indication not specifically listed above as meeting coverage criteria.
 
For fully-insured contracts subject to Act 583 of Arkansas legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications. (Effective August 1, 2021)
 
For members with contracts without primary coverage criteria, PET/CT for patients with Soft Tissue Sarcoma of the extremity, superficial trunk, head, and neck is considered investigational:  
    • For screening and surveillance*; OR
    • For any other indication not specifically listed above as meeting coverage criteria.
 
Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
 
Retroperitoneal/Intraabdominal/Gastrointestinal Stromal Tumors (GIST)
 
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
 
FDG-PET/CT meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for patients with Retroperitoneal/Intra-abdominal/Gastrointestinal Stromal Tumors:
 
Diagnostic Workup:  
Indicated in ANY of the following scenarios (all tumor types):  
    • Standard imaging cannot be performed or is nondiagnostic for metastatic disease; or
    • Standard imaging suggests a resectable solitary metastasis; or
    • Baseline study prior to neoadjuvant chemotherapy
 
Treatment Management:  
    • Indicated to assess treatment response following completion of neoadjuvant chemotherapy
 
For fully-insured contracts subject to Act 583 of Arkansas legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications. (Effective August 1, 2021)
 
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
PET/CT for patients with Retroperitoneal/Intraabdominal/Gastrointestinal Stromal Tumors does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes:  
    • For screening and surveillance*; OR
    • For any other indication not specifically listed above as meeting coverage criteria.
 
*For fully-insured contracts subject to Act 583 of Arkansas legislature, please see ABCBS policy 2021004, Surveillance and Other PET Oncologic Applications.  (Effective August 1, 2021)
 
For members with contracts without primary coverage criteria, PET/CT for patients with retroperitoneal/Intraabdominal/Gastrointestinal Stromal Tumors is considered investigational:  
    • For screening and surveillance*; OR
    • For any other indication not specifically listed above as meeting coverage criteria.
 
Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
Effective Prior to April 2021
 
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
 
PET scanning meets member certificate of benefit Primary Coverage Criteria for effectiveness for patients with soft tissue sarcoma for :
    •   Initial staging of soft tissue sarcoma because of the possibility of nodal metastases and the appearance of unusual sites of initial metastatic disease in adult patients.  
    •   Restaging after completion of a planned course of treatment if patient had a positive initial staging PET.
    •   Monitoring response after 2-4 weeks of imatinib therapy in patients with gastrointestinal stromal tumors (GIST)
 
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
PET scan imaging does not meet member certificate of benefit Primary Coverage Criteria for effectiveness for patients with soft tissue sarcoma for:
    •   Diagnosis of soft tissue sarcoma as studies to date have either shown wide sensitivity and specificity in detection of primary or metastatic disease and in differentiation between benign and malignant processes, or the number of patients studied for some uses has been small and the results are inconclusive.
    •   Surveillance of asymptomatic patients with no clinical, laboratory, or radiological evidence of recurrences as there are no studies which indicate improvement in health outcomes.
 
For those contracts without Primary Coverage Criteria, PET scanning is covered for:
    •   Initial staging of soft tissue sarcoma because of the possibility of nodal metastases and the appearance of unusual sites of initial metastatic disease in adult patients.  
    •    A repeat PET scan in patients who had a positive initial staging PET (may be repeated one time to evaluate the response to therapy).
    •   Monitoring response after 2-4 weeks of imatinib therapy in patients with gastrointestinal stromal tumors (GIST)
 
For those contracts without Primary Coverage Criteria, PET scanning is considered investigational and is not covered for:
    •   Diagnosis of soft tissue sarcoma as studies to date have either shown wide sensitivity and specificity in detection of primary or metastatic disease and in differentiation between benign and malignant processes, or the number of patients studied for some uses has been small and the results are inconclusive.
    •   Surveillance of asymptomatic patients with no clinical, laboratory, or radiological evidence of recurrences as there are no studies which indicate improvement in health outcomes.
 
 
Investigational services are an exclusion in the member certificate of coverage.
 

Rationale:
PET scans for patients with soft tissue sarcomas have been studied 1) to evaluate the accuracy of the test in diagnosing the disease initially; 2) to detect locoregional and distant metastases in patients with suspected recurrence; 3) to determine response to chemotherapy and estimate grade of tumor regression prior to surgery; 4) to predict pathologic grade of the tumor and other prognostic variables; and 5) to differentiate benign from malignant tumors preoperatively.
 
In one large prospective study of 202 patients with suspected primary bone tumors studied with PET, the sensitivity was 93%, the specificity was 67%, the positive predictive value was 79%, the negative predictive value was 88%, and an accuracy of 83%. False-negative results occurred in 6, and malignancy was falsely predicted for 29 benign lesions. (Schulte, 2000)
 
Another study of 18 patients with malignant bone tumors showed uptake of FDG in all 18; 31 of 39 benign lesions also had increased FDG uptake, but the degree of uptake for most of the benign lesions was less than in the malignant tumors (some benign lesions, however, had high uptake). The sensitivity of PET for detecting malignant disease was 100%, and the specificity was 77%. (Watanabe, 2000)
 
A third study of 43 patients with pathologically proven malignant sarcomas and 13 benign soft tissue tumors had a sensitivity of 76% a specificity of 43%, and an accuracy of 68%. (Dimitrakopoulou-Strauss, 2001)
 
A fourth study of patients with primary soft tissue sarcomas showed a sensitivity of 91% and specificity of 88%. Detection of local recurrence had a sensitivity of 88% and a specificity of 92%. (Schwarzbach, 2000)
 
Intermediate-grade and high-grade sarcomas appear to have a better detection rate. Low-grade tumors have commonly shown an FDG uptake equivalent to normal muscle tissue.
 
A study of 71 patients with histologically confirmed primary malignant bone tumors with suspected metastases to the lung showed a sensitivity of 50% and a specificity of 98%. (Franzius, 2001)
 
Sensitivity and specificity of PET for detecting osseous metastases from Ewing’s sarcoma appears to be considerably better than in the detection of osteogenic sarcoma. One study found a sensitivity of 100% and specificity of 96% for Ewing’s, but a 0% sensitivity for 5 patients with osteogenic sarcoma. Other studies have shown a greater sensitivity with PET for osteosarcomas than Ewing’s. (Franzius, 2000)
 
A small study of 17 patients with proven or suspected recurrence of soft tissue sarcoma studied with PET-FDG had a sensitivity of 93%. (Kole, 1997)
 
The differentiation of post-operative scarring from recurrent tumor has been reported in few patients; however, in the few patients reported, some had high uptake of FDG and some did not. (Watanabe, 2000)
 
The number of patients studied on the use of PET for monitoring preoperative chemotherapy response and estimating grade of tumor regression in patients with osteosarcoma before surgical removal of the tumor, compared to biopsy of the tumor to determine degree of tumor necrosis, are small, and conclusions cannot be determined on the effectiveness of PET used in this manner. (Franzius, 2000)
  
Treglia G, and colleagues (2012) performed a meta-analysis on data published on the diagnostic performance of FDG PET and PET/CT in patients with Ewing sarcoma family tumors (ESFT).  Studies that fulfilled the three following criteria were included in the systematic review: FDG-PET or PET/CT performed in patients with ESFT; articles about the diagnostic accuracy of FDG-PET and PET/CT; sample size of at least 10 patients with ESFT were included. Studies in which there were sufficient data to reassess sensitivity and specificity of FDG-PET or PET/CT in ESFT were included in the meta-analysis, excluding duplicate publications. Finally, pooled sensitivity, pooled specificity and area under the receiver operating characteristic (ROC) curve of FDG-PET or PET/CT in ESFT were calculated.  Thirteen studies comprising a total of 342 patients with ESFT were included in the review.  The meta-analysis of five selected studies provided these results about FDG-PET and PET/CT in ESFT: pooled sensitivity: 96% (95% confidence interval [CI] 91-99%); pooled specificity: 92% (95% CI 87-96%); area under the ROC curve: 0.97.  The authors concluded that in regard to the staging and restaging of patients with ESFT, the sensitivity, specificity and accuracy of FDG-PET and PET/CT are high; the combination of FDG-PET or PET/CT with conventional imaging is a valuable tool for the staging and restaging of ESFT and has a relevant impact on the treatment strategy plan.
 
NCCN Guidelines for Soft Tissue Sarcoma: Version 3.2012
  • PET scan may be useful in prognostication, grading and determining response to chemotherapy for lesions that are larger than 3 cm, firm, and deep, not superficial. (Schuetze, 2005)
  • In gastrointestinal stromal tumors (GIST), PET may give indication of imatinib activity after 2-4 weeks of therapy when rapid readout of activity is necessary.
  • In GIST, PET scan may be used to clarify, if CT or MRI is ambiguous in determining progression.
  • For rhabdomyosarcoma, PET scan may be useful for initial staging because of the possibility of nodal metastases and the appearance of unusual sites of initial metastatic disease in adults.
 
American College of Radiology Appropriateness Guidelines (June 2012) for FDG PET/CT imaging:
   (Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate)
 
  • Screening for pulmonary metastasis (primary malignancy: bone and soft tissue sarcoma)
     o Appropriateness rating: 5
 
Clinical Trials:
The value of combined PET/CT in predicting disease free survival (DFS) in patients receiving preoperative chemotherapy for STS is being evaluated in an ongoing large prospective study (NCT00346125 - estimated enrollment 70 with completion date April 2014).   
 
2014 Update
A literature search was conducted using the MEDLINE database through January 2014. There was no new literature that would prompt a change in the coverage statement.
 
2015 Update
A literature search conducted through January 2015 did not reveal any new information that would prompt a change in the coverage statement.
 
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.
 
December 2021 Update
A literature review was performed through September 2021. Following is a summary of the key literature to date.
 
DIAGNOSTIC WORKUP
Sarcomas are staged using the American Joint Committee on Cancer TNM system. Imaging of the primary tumor is important to assess resectability and local invasion. CT or MRI may be done as part of initial workup. However, MRI is often preferred for imaging the primary tumor due to superior resolution of tumor versus surrounding muscle and neurovascular bundles, and for delineating disease involving the pelvis. (2-7) In a large prospective trial comparing CT and MRI imaging in both soft tissue sarcomas and bone cancer, the accuracy of local staging was not statistically different between the 2 modalities. (8)
 
Imaging of the lungs is critical, as this is the most common site of metastases. Additional imaging recommendations for soft tissue sarcoma vary by subtype. Multiple studies have shown a correlation between FDG uptake and tumor grade, which is a strong indicator of prognosis. However, the evidence has not shown that PET significantly impacts staging or management. (9,10)
 
For Ewing sarcoma and osteosarcoma, NCCN recommends whole body PET/CT and/or bone scan as part of initial workup (level of evidence category 2A). (11) A meta-analysis showed a pooled sensitivity of 96% and pooled specificity of 92% for staging and restaging Ewing sarcoma when PET was combined with conventional imaging. (12) In another meta-analysis of 42 trials, PET had a pooled sensitivity and specificity of 96% and 79% for differentiating primary bone sarcomas from benign lesions, 92% and 93% for detecting recurrence, and 90% and 85% for detecting distant metastasis, respectively. (13)
 
MANAGEMENT
PET has been shown to be a useful adjunct in assessing treatment response to neoadjuvant therapy, as well as an indicator of prognosis. (11-13) A review and meta-analysis of 11 studies confirmed the prognostic value of PET response to overall survival in soft tissue and bone sarcoma. (14,15)
 
SURVEILLANCE
Imaging of the primary site for soft tissue sarcoma is based on the risk of recurrence and the accessibility of the primary cancer site. (16) Particularly for younger patients where the radiation risks from multiple CT examinations might cause some concern, the follow up can be performed with MRI of the abdomen and pelvis supplemented with CT thorax.
 
Current References
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. PMID: 31912902
    2. Aisen AM, Martel W, Braunstein EM, et al. MRI and CT evaluation of primary bone and soft-tissue tumors. AJR Am J Roentgenol. 1986;146(4):749-56. PMID: 3485348
    3. Demas BE, Heelan RT, Lane J, et al. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR Am J Roentgenol. 1988;150(3):615-20. PMID: 3257620
    4. Manaster BJ. Soft-tissue masses: optimal imaging protocol and reporting. AJR Am J Roentgenol. 2013;201(3):505-14. PMID: 23971442
    5. Sundaram M, McGuire MH, Herbold DR. Magnetic resonance imaging of soft tissue masses: an evaluation of fifty-three histologically proven tumors. Magn Reson Imaging. 1988;6(3):237-48. PMID: 3398729
    6. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Gastrointestinal Stromal Tumors (GISTs) (Version 1.2021). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2021.
    7. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma (Version 1.2021). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2021.
    8. Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the Radiology Diagnostic Oncology Group. Radiology. 1997;202(1):237-46. PMID: 8988217
    9. Schuetze SM. Utility of positron emission tomography in sarcomas. Curr Opin Oncol. 2006;18(4):369-73. PMID: 16721133
    10. Eary JF, O'Sullivan F, Powitan Y, et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: a retrospective analysis. Eur J Nucl Med Mol Imaging. 2002;29(9):1149-54. PMID: 12192559
    11. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Bone Cancer (Version 1.2021). Available at http://www.nccn.org. ©National Comprehensive Cancer Network, 2021.
    12. Treglia G, Salsano M, Stefanelli A, et al. Diagnostic accuracy of 18F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis. Skeletal Radiol. 2012;41(3):249-56. PMID: 22072239
    13. Liu F, Zhang Q, Zhu D, et al. Performance of positron emission tomography and positron emission tomography/computed tomography using fluorine-18-fluorodeoxyglucose for the diagnosis, staging, and recurrence assessment of bone sarcoma: a systematic review and meta-analysis.[Erratum appears in Medicine (Baltimore). 2016 Jan;95(2):e187a Note: Liu, Fengxia [Added]]. Medicine (Baltimore). 2015;94(36):e1462. PMID: 26356700
    14. Li YJ, Dai YL, Cheng YS, et al. Positron emission tomography (18)F-fluorodeoxyglucose uptake and prognosis in patients with bone and soft tissue sarcoma: a meta-analysis. Eur J Surg Oncol. 2016;42(8):1103-14. PMID: 27189833
    15. Chen L, Wu X, Ma X, et al. Prognostic value of 18F-FDG PET-CT-based functional parameters in patients with soft tissue sarcoma: a meta-analysis. Medicine (Baltimore). 2017;96(6):e5913. PMID: 28178131
    16. Patel SR, Zagars GK, Pisters PW. The follow-up of adult soft-tissue sarcomas. Semin Oncol. 2003;30(3):413-6. PMID: 12870143
 

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

References: Al-Ibraheem A, Buck AK, Benz MR, et al.(2012) F-Fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer. 2012 Dec 11. doi: 10.1002/cncr.27866.

American College of Radiology.(2010) ACR Appropriateness Criteria: Soft Tissue Sarcoma www.acr.org; last accessed 1/30/2012.

Dimitrakopoulou-Strauss A, Strauss LG, Schwarzbach M, et al.(2001) Dynamic PET 18F-FDG studies in patients with primary and recurrent soft-tissue sarcomas: impact on diagnosis and correlation with grading. J Nucl Med, 2001; 42:713-720.

Eary JF, Conrad EU, Bruckner JD, et al.(1998) Quantitative [F-18] fluorodeoxyglucose positron emission tomography in pretreatment and grading of sarcoma. Clin Cancer Res, 1998; 4:1215-1220.

Folpe AL, Lyles RH, Sprouse JT, et al.(2000) (F-18) fluorodeoxyglucose positron emission tomography as a predictor of pathologic grade and other prognostic variables in bone and soft tissue sarcoma. Clin Cancer Res, 2000; 6:1279-1287.

Franzius C, Daldrup-Link HE, Sciuk J, et al.(2001) FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol, 2001; 12:479-486.

Franzius C, Sciuk J, Brinkschmidt C, et al.(2000) Evaluation of chemotherapy response in primary bone tumors with F-18 FDG positron emission tomography compared with histologically assessed tumor necrosis. Clin Nucl Med, 2000; 25:874-881.

Franzius C, Sciuk J, Daldrup-Link HE, et al.(2000) FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med, 2000; 27:1305-1311.

Garcia R, Kim EE, Wong FC, et al.(1996) Comparison of fluorine-18-FDG PET and technetium-99m-MIBI SPECT in evaluation of musculoskeletal sarcomas. J Nucl Med, 1996;37:1476-1479.

Kole AC, Nieweg OE, van Ginkel RJ, et al.(1997) Detection of local recurrence of soft-tissue sarcoma with PET using FDG. Ann Surg Oncol, 1997; 4:57-63.

Lucas JD, O’Doherty MJ, Cronin BF.(1999) Prospective evaluation of soft tissue masses and sarcomas using fluorodeoxyglucose positron emission tomography. Br J Surg, 1999; 86:550-556.

National Comprehensive Cancer Network.(2012) NCCN Guidelines for Soft Tissue Sarcoma, Version 3.2012. www.nccn.org; last accessed 1/30/2013.

NCT00346125(2013) An Evaluation of PET/CT Imaging as a Predictor of Disease Free Survival Following Neo-Adjuvant Chemotherapy for Soft Tissue Sarcoma. www.clinicaltrials.gov; last accessed 1/30/2013

Schuetze SM, Rubin BP, Vernon C, et al.(2005) Use of positron emission tomography in localized extremity soft tissue sarcoma treated with neoadjuvant chemotherapy. Cancer 2005; 103:339-348.

Schulte M, Brecht-Krauss D, Heymer B, et al.(2000) Grading of tumors and tumorlike lesions of bone: Evaluation by FDG PET. J of Nucl Med, 2000; 41:1695-1701.

Schulte M, Brecht-Krauss, Werner M, et al.(1999) Evaluation of neoadjuvant therapy response of osteogenic sarcoma using FDG PET. J Nucl Med, 1999; 40:1637-1643.

Schwarzbach M, Willeke F, Dimitrakopoulou-Strauss A, et al.(1999) Functional imaging and detection of local recurrence in soft tissue sarcomas by positron emission tomography. Anticancer Res, 1999; 19:1343-1349.

Schwarzbach MH, Dimitrakopoulou-Strauss A, Willeke F, et al.(2000) Clinical value of FDG PET imaging in soft tissue sarcomas. Ann Surg, 2000; 231:380-386.

Treglia G, Salsano M, Stefanelli A, et al.(2012) Diagnostic accuracy of ¹8F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis. Skeletal Radiol. 2012 Mar;41(3):249-56.

Varma DG.(2000) Imaging of soft-tissue sarcomas. Curr Oncol Rep, 2000; 2:487-490.

Watanabe H, Shinozaki T, Yanagawa T, et al.(2000) Glucose metabolic analysis of musculoskeletal tumours using FDG PET as an aid to preoperative planning. J of Bone & Joint Surg, 2000; 82-B:760-767.

Yoshikawa K, Shimada M, Kurita N, et al.(2012) The efficacy of PET-CT for predicting the malignant potential of gastrointestinal stromal tumors. Surg Today. 2012 Nov 11.


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 © 2022 American Medical Association.