Recommendations For PET/CT Guidelines

Appropriate

• There is evidence of improved diagnostic performance(higher sensitivity and specificity) compared with other current techniques

• The information derived from PET scan influences clinical practice

• The information derived from the PET scan has a plausible impact on the patient’s outcome

Potentially Appropriate

• There is evidence of improved diagnostic performance compared with other techniques but evidence of an impact on treatment is lacking.

Possibly Appropriate

• (appropriateness not documented)

• There is insufficient evidence of assessment, although there is a strong rationale for clinical benefit from PET

Inappropriate

Improved accuracy of tumor staging will not alter management. The performance of PET is poorer from other current techniques.

Inappropriate

[Head and Neck Cancers]

Diagnosis - Characterization of mass lesion

Inappropriate

[Head and Neck Cancers]

Diagnosis - PET Guided Biopsy

Appropriate

[Head and Neck Cancers]

Diagnosis - Cervical Adenopathy with occult primary

Appropriate

[Head and Neck Cancers]
Response evaluation

Inappropriate

[Head and Neck Cancers]
Restaging - End of Therapy

Appropriate

[Head and Neck Cancers]
Restaging - Confirmed Recurrence

Appropriate

[Head and Neck Cancers]
Suspected Recurrence

Inappropriate

[Head and Neck Cancers]
Follow-up

Potentially Appropriate

[Head and Neck Cancers]
RT planning

Inappropriate

[Thyroid Cancer]
Diagnosis

Inappropriate

[Thyroid Cancer]
Response evaluation

Appropriate

[Thyroid Cancer]
Restaging / suspected recurrence - Differentiated thyroid cancer

Potentially appropriate

[Thyroid Cancer]
Restaging/ Suspected recurrence: Medullary Thyroid cancer

Inappropriate

[Thyroid Cancer]
Follow-up

Inappropriate

[Thyroid Cancer]
RT planning

inappropriate

[Breast Cancer]
Diagnosis

Inappropriate

[Breast Cancer]
Staging - Axila

Potentially Appropriate

[Breast Cancer]
Staging - Distant metastases

Inappropriate

[Breast Cancer]
Restaging - end of therapy

Potentially Appropriate

[Breast Cancer]
Restaging - Confirmed Recurrence

Potentially Appropriate

[Breast Cancer]
Suspected Recurrence

Inappropriate

[Breast Cancer]
Follow-up

Possibly appropriate

[Breast Cancer]
RT planning

Appropriate

[Non-small cell lung carcinoma]
Diagnosis - characterization of primary nodule

Appropriate

[Non-small cell lung carcinoma]
Staging - Regional Lymph nodes

Appropriate

[Non-small cell lung carcinoma]

Staging - Distant Metastases

Potentially Appropriate

[Non-small cell lung carcinoma]

Response evaluation - Following neoadjuvant chemotherapy

Inappropriate

[Non-small cell lung carcinoma]

Response evaluation - Following definitive chemotherapy or chemoradiation

possibly appropriate

[Non-small cell lung carcinoma]

Response evaluation - During definitive chemotherapy

Inappropriate

[Non-small cell lung carcinoma]

Restaging - End of Therapy

Potentially Appropriate

[Non-small cell lung carcinoma]

Restaging - Confirmed Recurrence

Potentially Appropriate

[Non-small cell lung carcinoma]

Suspected Recurrence

Inappropriate

[Non-small cell lung carcinoma]

Follow-up

Potentially appropriate

[Non-small cell lung carcinoma]

RT planning

Inappropriate

[Esophageal Cancer]

Diagnosis - Characterization of mass lesions

Inappropriate

[Esophageal Cancer]

Diagnosis - PET Guided Biopsy

Appropriate

[Esophageal Cancer]

Staging

Potentially Appropriate

[Esophageal Cancer]

Response evaluation

Inappropriate

[Esophageal Cancer]

Restaging

Potentially appropriate

[Esophageal Cancer]

Suspected Reccurence

Inappropriate

[Esophageal Cancer]

Follow-up

Potentially appropriate

[Esophageal Cancer]

RT planning

Inappropriate

[Colorectal Cancer]

Diagnosis - Characterization of mass lesions

Inappropriate

[Colorectal Cancer]

Diagnosis - PET Guided Biopsy

Potentially Appropriate

[Colorectal Cancer]

Staging

Potentially Appropriate

[Colorectal Cancer]

Response evaluation

Appropriate

[Colorectal Cancer]

Restaging

Potentially appropriate

[Colorectal Cancer]

Suspected Recurrences

Possibly Appropriate

[Colorectal Cancer]

Follow-up

Possibly appropriate

[Colorectal Cancer]

RT planning

Inappropriate

[Cancer of the Uterus and Cervix]

Diagnosis

Appropriate

[Cancer of the Uterus and Cervix]

Staging

Possibly appropriate

[Cancer of the Uterus and Cervix]

Response evaluation

Inappropriate

[Cancer of the Uterus and Cervix]

Restaging: end of therapy

—

[Cancer of the Uterus and Cervix]

Restaging: Suspected recurrence

—

[Cancer of the Uterus and Cervix]

RT planning

Inappropriate

[Melanoma]
Diagnosis

Inappropriate

[Melanoma]
Staging - Stages I and II pretest probability of Metastases

appropriate

[Melanoma]
Staging - Stages I and II high pretest probability of metastases

potentially appropriate

[Melanoma]
Staging - Stage III or potential Stage IV

Inappropriate

[Melanoma]
Response evaluation

Inappropriate

[Melanoma]
Staging -End of Treatment

Appropriate

[Melanoma]
Staging - Confirmed recurrence

Possibly Appropriate

[Melanoma]
Suspected recurrence

Inappropriate

[Melanoma]
Follow-up

Inappropriate

[Melanoma]
RT planning

Inappropriate

[Lymphoma]
Diagnosis

Inappropriate

[Lymphoma]
Staging

Appropriate

[Lymphoma]
Response evaluation

Appropriate

[Lymphoma]

Restaging

Appropriate

[Lymphoma]

Suspected recurrence

Inappropriate

[Lymphoma]

Follow-up

Inappropriate

[Lymphoma]

RT planning

Appropriate

[Inflammation and Infection]

• Sarcoidosis

• Peripheral Bone osteomyelitis(non post-operative, non-diabetic foot)

• Suspected Spinal infection

• Evaluation of Fever of Unknown origin(FUO)

• Evaluation of metastatic infection of high risk patients with bacteremia

• Primary evaluation of Vasculitides

Potentially Appropriate

[Inflammation and Infection]

• Evaluation of Potentially infected liver and kidneys in polycystic disease

• Suspected infection of intravascular devices, pacemakers and catheters

• AIDS-Associated opportunistic infection, associated tumors and Castleman disease

• Assessment of metabolic activity in tuberculosis lesions

Possibly Appropriate

[Inflammation and Infection]

• Diabetic foot infections

• Joint prosthetic infections 

• Vascular Prosthetic infections 

• Inflammatory bowel disease 

• Endocarditis

Dementing Disorders

indications include early diagnosis and differential diagnosis of dementing disorders such as alzheimers’s disease and frontotemporal dementia

Neurooncology

PET CT can be used in differential diagnosis in cerebral space occupying lesions, detection of viable tumor tissue

Epilepsy

A common indication(interictal injection) is the preoperative evaluation of partial epilepsy in adults and in children to identify the functional deficit zone

Movement Disorders

Used to differentiate Parkinsons from atypical parkinsonian syndromes

• Pregnancy

• Breastfeeding (should interrupt for 24 hours if PET is indicated)

• Lack of cooperation or inability to cooperate with the procedure

Contraindications