We have previously reported that PET with ¹⁸F-fluoride (NaF PET) for assessment of osseous metastatic disease led to changes in intended management in a substantial fraction of patients with prostate or other types of cancer participating in the National Oncologic PET Registry. This study was performed to assess the concordance of intended patient management after NaF PET and inferred management based on analysis of Medicare claims. Methods: We analyzed linked post–NaF PET data of consenting National Oncologic PET Registry participants age 65 y or older from 2011 to 2014 and their corresponding Medicare claims. Post–NaF PET treatment plans, including combinations of 2 modes of therapy, were assessed for their concordance with clinical actions inferred from Medicare claims. NaF PET studies were stratified by indication (initial staging [IS] or suspected first osseous metastasis [FOM]) and cancer type (prostate, lung, or other cancers). Agreement was assessed between post–NaF PET intended management plans for treatment (surgery, radiotherapy, or systemic therapy) within 90 d for lung and 180 d for prostate or other cancers, and for watching (the absence of treatment claims for ≥60 d) as compared with claims-inferred care. Results: Actions after 9,898 scans were assessed. After NaF PET for IS, there was claims agreement for planned surgery in 76.0% (19/25) lung, 75.4% (98/130) other cancers, and 58.9% (298/506) prostate cancer. Claims confirmed chemotherapy plans after NaF PET done for IS or FOM in 81.0% and 73.5% for lung cancer (n = 148 and 136) and 69.4% and 67.5% for other cancers (n = 111 and 228). For radiotherapy plans, agreement ranged from 80.0% to 84.4% after IS and 68.4% to 74.0% for suspected FOM. Concordance was greatest for androgen deprivation therapy (ADT) (86.0%, n = 308) alone or combined with radiotherapy in prostate cancer IS (80.8%, n = 517). In prostate FOM, the concordance across all treatment plans was lower if the patients had ADT claims within 180 d before NaF PET. Agreement with nontreatment plans was high for FOM (87.2% in other cancers and 78.6% if no prior ADT in prostate) and low after IS (40.7%–62.5%). Conclusion: Concordance of post–NaF PET plans and claims was substantial and higher overall for IS than for FOM.

我们以前曾报道过，使用¹⁸ F-氟化物（NaF PET）评估骨转移性疾病的PET导致参与国家肿瘤PET登记的大部分前列腺癌或其他类型癌症患者的预期治疗发生了变化。进行这项研究是为了评估NaF PET后预期患者治疗与根据Medicare索赔分析推断出的治疗之间的一致性。方法：我们分析了2011年至2014年年龄在65岁或以上的国家肿瘤PET注册管理中心同意的参与者的NaF后PET数据及其相应的Medicare索赔。对NaF后PET治疗计划（包括两种治疗模式的组合）进行了评估，以评估其与从Medicare索赔中推断出的临床行为的一致性。NaF PET研究按适应症（初始分期[IS]或疑似第一骨转移[FOM]）和癌症类型（前列腺癌，肺癌或其他癌症）进行分层。在NaF PET术后90天内针对肺部治疗，180前列腺癌或其他癌症中的治疗（手术，放疗或全身治疗）的预期管理计划之间进行了评估，并进行了观察（对于≥60 d的治疗无要求）与索赔推断的护理相比。结果：评估了9,898次扫描后的行动。在将NaF PET用于IS后，已达成协议，计划在76.0％（19/25）的肺癌，75.4％（98/130）的其他癌症和58.9％（298/506）的前列腺癌中计划手术。权利要求书确定化疗方案后的NaF PET在81.0％为IS或FOM完成，肺癌（73.5％Ñ = 148和136）和69.4％和67.5％对其他癌症（Ñ = 111和228）。对于放射治疗计划，在IS后达成协议的范围从80.0％到84.4％，对于可疑FOM达成的协议范围从68.4％到74.0％。一致性为最大的雄激素剥夺疗法（ADT）（86.0％，Ñ = 308）单独使用或与在前列腺癌放疗联合IS（80.8％，Ñ= 517）。在前列腺FOM中，如果患者在NaF PET前180天内有ADT主张，则所有治疗计划的一致性较低。FOM与非治疗计划的同意率很高（在其他癌症中为87.2％，如果前列腺癌之前没有ADT，则为78.6％），而在IS后则较低（40.7％–62.5％）。结论： NaF后PET计划和声明的一致性很高，IS的整体性高于FOM。