Good clinical practice recommendations for the use of PET/CT in oncology
Positron emission tomography/computed tomography (PET/CT) is a nuclear medicine functional imaging technique with proven clinical value in oncology. PET/CT indications are continually evolving with fresh advances made through research. French practice on the use of PET in oncology was framed in recommendations based on Standards–Options–Recommendations methodology and coordinated by the French federation of Comprehensive Cancer Centres (FNLCC). The recommendations were originally issued in 2002 followed by an update in 2003, but since then, a huge number of scientific papers have been published and new tracers have been licenced for market release. The aim of this work is to bring the 2003 version recommendations up to date. For this purpose, a focus group was set up in collaboration with the French Society for Nuclear Medicine (SFMN) to work on developing good clinical practice recommendations. These good clinical practice recommendations have been awarded joint French National Heath Authority (HAS) and French Cancer Institute (INCa) label status—the stamp of methodological approval. The present document is the outcome of comprehensive literature review and rigorous appraisal by a panel of experts, organ specialists, clinical oncologists, surgeons and imaging specialists. These data were also used for the EANM referral guidelines.
KeywordsPositron emission tomography Computed tomography Methodological approval
The list of reviewers is available in the thesaurus.
INCa and HAS project managers
MOROIS Sophie, Project manager in the Good Practices Department, INCa
DUPERRAY Marianne, Head of the Good Practices Department, INCa
DAHAN Muriel, Director of the Recommendations and Drugs Department, INCa
VERMEL Christine, Responsible for the quality mission and conformity of the expertise, INCa
LAURENCE Michel, Head of the Good Professional Practice Department, HAS
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 1.Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, et al. Diagnostic efficacy of (68)Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol. 2016;195(5):1436–43.CrossRefGoogle Scholar
- 6.Yaxley JW, Raveenthiran S, Nouhaud FX, Samartunga H, Yaxley AJ, Coughlin G, et al. Outcomes of primary lymph node staging of intermediate and high risk prostate cancer with (68)Ga-PSMA positron emission tomography/computerized tomography compared to histological correlation of pelvic lymph node pathology. J Urol. 2019;201(4):815–20.CrossRefGoogle Scholar
- 7.Kim SJ, Lee SW, Ha HK. Diagnostic performance of radiolabeled prostate-specific membrane antigen positron emission tomography/computed tomography for primary lymph node staging in newly diagnosed intermediate to high-risk prostate cancer patients: a systematic review and meta-analysis. Urol Int. 2019;102(1):27–36.CrossRefGoogle Scholar
- 8.Gupta M, Choudhury PS, Rawal S, Goel HC, Singh A, Talwar V, et al. Risk stratification and staging in prostate cancer with prostatic specific membrane antigen PET/CTObjective: a one-stop-shop. Hell J Nucl Med. 2017;20(Suppl:156).Google Scholar
- 10.Dyrberg E, Hendel HW, Huynh THV, Klausen TW, Logager VB, Madsen C, et al. (68)Ga-PSMA-PET/CT in comparison with (18)F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study. Eur Radiol. 2019;29(3):1221–30.CrossRefGoogle Scholar
- 13.Roach PJ, Francis R, Emmett L, Hsiao E, Kneebone A, Hruby G, et al. The impact of (68)Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. Journal of nuclear medicine: official publication, Society of Nuclear Medicine. 2018;59(1):82–8.CrossRefGoogle Scholar
- 15.De Bari B, Mazzola R, Aiello D, Aloi D, Gatta R, Corradini S, et al. ((68)Ga)-PSMA-PET/CT for the detection of postoperative prostate cancer recurrence: possible implications on treatment volumes for radiation therapy. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2019;23(3):194–200.CrossRefGoogle Scholar
- 17.Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2019.Google Scholar
- 20.Pfister D, Porres D, Heidenreich A, Heidegger I, Knuechel R, Steib F, et al. Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with (68)Ga-PSMA-HBED-CC than with (18)F-fluoroethylcholine PET/CT. Eur J Nucl Med Mol Imaging. 2016;43(8):1410–7.CrossRefGoogle Scholar
- 21.Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G, et al. Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. Journal of nuclear medicine: official publication, Society of Nuclear Medicine. 2016;57(11):1713–9.CrossRefGoogle Scholar
- 22.Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;70(6):926–37.CrossRefGoogle Scholar