Appropriate Use Criteria for ¹⁸F-FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease

Abstract

† Breast cancer, colon cancer, lung cancer, lymphoma, melanoma, sarcoma, and head and neck cancer.‡ Patient management includes diagnostic management and treatment management. § Patient clinical outcomes include overall survival, event-free survival, progression-free survival, disease-specific survival, disease-free survival, skeletal-related events, or change in outcome.

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

“…There is evidence of the efficacy of 18 F FDG PET/CT in selected clinical indications (Boellaard et al, 2015), and appropriate use criteria (AUC) have been published (Jadvar et al, 2017). Clinical situations where 18 F FDG PET/CT presents high efficacy and has an impact on management are:…”

Role of 18FDG PET/CT in Breast Cancer

“…National Comprehensive Cancer Network (NCCN) in its narrative summary, published in February 2016, discourages the use of 18 FDG in staging of patients with primary operable and metastatic (stage IV) BC. 6 However, it favours the use of 18 FDG in staging of locally advanced BC (LABC) and inflammatory BC (IBC). American Society of Clinical Oncology (ASCO) recommends 18 FDG PET/CT for staging in patients with high clinical suspicion of metastasis and recurrence.…”

“…American Society of Clinical Oncology (ASCO) recommends 18 FDG PET/CT for staging in patients with high clinical suspicion of metastasis and recurrence. Recently published appropriate use criteria (AUC) by Society of Nuclear Medicine and Molecular Imaging (SNMMI), 6 favour the role of 18 FDG PET/CT in restaging and predicting response to therapy in BC. It is imperative for reporting physicians and referring oncologists to be cognizant of the justified indications of 18 FDG PET/CT and also its limitations in different clinical scenarios.…”

Bone radionuclide therapy and increased survival with radium-223 is the way to go for nuclear medicine: the offer that oncologists cannot refuse

“…However, due to the lack of solid evidence, it is difficult, if not impossible, to appropriately discuss its inclusion in clinical algorithms. On one hand, this is quite a common situation, as obtaining high-quality evidence requires randomised controlled trials or very well designed and performed studies, that are very difficult to achieve in the clinical field, especially when the preferred diagnostic test in guidelines is CT or MR [3]. When these are lacking, there is the possibility of performing systematic reviews and meta-analyses, which have become a way of providing evidence in difficult clinical questions [4][5][6].…”

“…The best example is 18 F-FDG PET, which after so many years is still struggling to be considered the standard diagnostic imaging test in some oncological indications where, based on expert opinion, it is clearly useful [2,3]. However, due to the lack of solid evidence, it is difficult, if not impossible, to appropriately discuss its inclusion in clinical algorithms.…”