A single18-fluorodeoxyglucose PET scan would be covered for staging biopsy-proven cervical cancer under a proposal issued by the Centers for Medicare and Medicaid Services.
The agency is soliciting public comments on the proposed decision and anticipates receiving expert opinion and professional society position statements before issuing a final decision.
The CMS is recommending against coverage of 18-fluorodeoxyglucose (FDG) PET imaging for the initial diagnosis of cervical cancers, since “there is no credible evidence that the results of FDG PET imaging are useful” for this indication, according to the proposal.
Prospective data collection on FDG PET imaging for initial staging of cervical cancer and evidence analysis led CMS to conclude that the results are “used by the treating physician to make meaningful changes in therapeutic management and improve health outcomes and thus are reasonable and necessary.”
CMS proposes to cover one FDG PET when performed to determine the location or extent of the tumor for the following purposes related to the initial treatment strategy:
▸ To determine whether the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure; or
▸ To determine the optimal anatomic location for an invasive procedure; or
▸ To determine the anatomic extent of tumor when the recommended antitumor treatment reasonably depends on the extent of the tumor.
The finding of distant metastases, in particular to the supraclavicular lymph nodes, changes the treatment strategy for cervical cancer. “Compared with other non-invasive methods, FDG PET is more sensitive in determining lymph node involvement in initial assessment of cervical cancer,” the proposal said. In addition, the published literature supports the beneficial effect of this strategy on initial treatment planning, “with the majority of the effect being avoidance of futile surgery,” CMS said.
More information is available at https://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?from2=viewdraftdecisionmemo.asp&id=232&