PET Center Name
PET Center Address
PET Center Phone and Fax Number
Patient Name:
Policy Number:
Date of Service:
To Whom It May Concern:
(Insert patient name) is a patient of ours that was diagnosed with Ovarian Cancer in
(insert date). Which was treated with a surgical resection and chemotherapy (carboplatin
and Taxol). She had a recurrence in (insert year) which was treated with surgery and
chemotherapy.
In (insert year) she had another recurrence which was treated with chemotherapy and
radiation, treatment ended in (insert date) which she then had a PET/CT scan to restage
her which was negative for new disease and a good response to the previously noted
disease.
For follow up in September her CT showed some small lung nodules and a continuing
decrease in the pelvic soft tissue mass and some axillary lymphadenopathy. She was
scheduled to have a follow up PET/CT in November to characterize the lung nodules and
axillary lymphadenopathy as well as determine continued response of chemotherapy in
the pelvic mass.
(Insert patient name) had her PET/CT on (insert date) to restage her disease and she
was found to be free of active disease. Both of her PET/CT scans ((insert date) were
helpful in restaging her disease, and should be reconsidered for payment. According to
the recent Medicare NOPR study, PET/CT for restaging of ovarian cancer changed
management in over 30% of the patients studied, and was the number one cancer
entered into the NOPR data.
Recent Data from a study performed at (Insert PET Center name) (enclosed) shows the
sensitivity of FDG PET/CT for Ovarian Cancer is 88.4% and conventional imaging 75.1%.
And a specificity of 88.2% and conventional imaging 64.4% Patients with recurrent
ovarian cancer have a higher rate of successful treatments if the cancer is found early
and determination of surgery is identified. PET/CT was and is an extremely important
imaging modality in making management decisions for ovarian cancer patients.
Thank you for your reconsideration in this matter.
Thank you for your time and consideration,
Sincerely,