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Recommendations on the Use of ¹⁸F-FDG PET in Oncology

¹ Indiana University School of Medicine, Indianapolis, Indiana; ² H. Lee Moffitt Cancer Center at University of South Florida, Tampa, Florida; ³ Washington University School of Medicine, St. Louis, Missouri; ⁴ Mayo Clinic, Rochester, Minnesota; ⁵ Duke University Medical Center, Durham, North Carolina; ⁶ Johns Hopkins Medical Center, Baltimore, Maryland; ⁷ US Oncology, Newport News, Virginia; ⁸ Queen Mary's School of Medicine and Dentistry, London, United Kingdom; ⁹ Brigham and Women's Hospital, Boston, Massachusetts; ¹⁰ Blue Cross and Blue Shield Association, Washington, DC; ¹¹ Vanderbilt University Medical Center, Nashville, Tennessee; ¹² National Coalition for Cancer Survivorship, Washington, DC; and ¹³ Karmanos Cancer Institute, Detroit, Michigan

Correspondence: For correspondence or reprints contact: James W. Fletcher, MD, Department of Radiology, Indiana/Purdue University, Indiana University School of Medicine, University Hospital, Room 0655, 550 N. University Blvd. Indianapolis, IN 46202-5253. E-mail: jwfletch{at}iupui.edu

The rationale was to develop recommendations on the use of ¹⁸F-FDG PET in breast, colorectal, esophageal, head and neck, lung, pancreatic, and thyroid cancer; lymphoma, melanoma, and sarcoma; and unknown primary tumor. Outcomes of interest included the use of ¹⁸F-FDG PET for diagnosing, staging, and detecting the recurrence or progression of cancer. Methods: A search was performed to identify all published randomized controlled trials and systematic reviews in the literature. An additional search was performed to identify relevant unpublished systematic reviews. These publications comprised both retrospective and prospective studies of varied methodologic quality. The anticipated consequences of false-positive and false-negative tests when evaluating clinical usefulness, and the impact of ¹⁸F-FDG PET on the management of cancer patients, were also reviewed. Results and Conclusion: ¹⁸F-FDG PET should be used as an imaging tool additional to conventional radiologic methods such as CT or MRI; any positive finding that could lead to a clinically significant change in patient management should be confirmed by subsequent histopathologic examination because of the risk of false-positive results. ¹⁸F-FDG PET should be used in the appropriate clinical setting for the diagnosis of head and neck, lung, or pancreatic cancer and for unknown primary tumor. PET is also indicated for staging of breast, colon, esophageal, head and neck, and lung cancer and of lymphoma and melanoma. In addition, ¹⁸F-FDG PET should be used to detect recurrence of breast, colorectal, head and neck, or thyroid cancer and of lymphoma.

Key Words: oncology • PET • ¹⁸F-FDG PET

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