CLINICAL INDICATIONS FOR 18F-FDG PET/CT IN ONCOLOGY
SMALL CELL AND NON-SMALL CELL LUNG CANCER
Characterization of solitary pulmonary nodule, with transverse diameter ≥8mm, with
radiological characteristics of intermediate probability for malignancy
MESOTHELIOMA
Staging of patients with malignant thymus gland neoplasm who are candidates for radical surgical treatment.
- Staging of patients with non-small cell and small cell lung cancer with limited disease on conventional imaging, who are considered candidates for radical therapy.
- Restaging of patients with non-small cell lung cancer after concurrent chemo/radiotherapy.
- When suspecting recurrence of non-small cell lung cancer - differential diagnosis between recurrence and post-treatment changes.
Characterization of solitary pulmonary nodule, with transverse diameter ≥8mm, with
radiological characteristics of intermediate probability for malignancy
MESOTHELIOMA
- Pleural thickening suspicious for malignancy for biopsy site selection.
- Confirmed mesothelioma to exclude extrathoracic disease in patients who are candidates for radical surgical treatment.
Staging of patients with malignant thymus gland neoplasm who are candidates for radical surgical treatment.
- Initial staging of HODGKIN and non-HODGKIN lymphomas
- Early assessment after 2-3 cycles of chemotherapy (interim PET/CT) of selected HODGKIN lymphomas, if results will affect treatment.
- Re-examination of HODGKIN and non-HODGKIN lymphomas (subtypes with known 18F-FDG uptake) after completion of treatment, to investigate residual disease.
- Investigation of suspected recurrence of HODGKIN and non-HODGKIN lymphoma
- When suspecting transformation of low-grade lymphoma or chronic lymphocytic leukemia to high-grade lymphoma.
- Initial staging (for distant metastases)
- Restaging, monitoring for recurrence in patients under immunotherapy
- Differentiated thyroid cancer: When recurrence is suspected (if whole-body scan with I-131 is negative and thyroglobulin is elevated).
- Medullary thyroid carcinoma: When recurrence is suspected (when calcitonin is elevated and other tests are negative or ambiguous) - Examination with 18F-FDOPA.
- Initial staging and restaging in poorly differentiated thyroid cancer (undifferentiated carcinoma, anaplastic carcinoma, Hurthle cell carcinoma).
- Search for primary site in patients with cervical lymph node metastases from squamous cell carcinoma.
- Staging.
- Response monitoring 3-6 months after chemo/radiotherapy.
- When recurrence is suspected and other imaging tests are ambiguous.
STOMACH AND ESOPHAGEAL CANCER
COLORECTAL CANCER
ANAL CANCER
GASTROINTESTINAL STROMAL TUMORS (GIST)
- Initial staging in patients who are candidates for radical surgical treatment.
- Restaging after treatment.
- When recurrence is suspected and other imaging tests are ambiguous.
COLORECTAL CANCER
- Staging before therapeutic metastasectomy.
- Detection of recurrence in patients with elevated tumor markers and/or clinical suspicion, with negative/ambiguous findings from other imaging tests.
- Response monitoring for targeted interventional techniques (radiofrequency ablation, chemo/radioembolization) or chemo/radiotherapy.
ANAL CANCER
- Initial staging.
- Response monitoring after chemo-radiotherapy.
- Monitoring for residual disease or recurrence.
GASTROINTESTINAL STROMAL TUMORS (GIST)
- Staging of patients who are candidates for molecular targeted therapy.
- Response monitoring to molecular targeted therapy.
- Assessment of patients with known pancreatic cancer who are candidates for radical surgery, with other imaging findings negative/ambiguous for metastatic disease and restaging after preoperative therapy.
- When pancreatic cancer recurrence is suspected, with suspicious findings in conventional imaging.
- Assessment of patients with known cholangiocarcinoma or high-grade hepatocellular carcinoma who are candidates for radical surgery or transplantation, with other imaging findings negative/ambiguous for metastatic disease.
- When recurrence of cholangiocarcinoma or high-grade hepatocellular carcinoma is suspected, with ambiguous results in conventional imaging.
- Response monitoring for targeted interventional techniques (radiofrequency ablation, chemo/radioembolization) or chemo/radiotherapy.
- Staging/restaging and detection of recurrence in well-differentiated neuroendocrine tumors. Examination with DOTA-peptides.
- Staging/restaging and detection of recurrence in poorly differentiated neuroendocrine tumors. Examination with 18F-FDG.
- Staging and restaging of vulvar, cervical, and endometrial cancer in patients who are candidates for radical therapy (especially in cervical cancer, other imaging methods should precede).
- Response monitoring to chemo/radiotherapy in locally advanced cervical cancer.
- Suspected recurrence of vulvar, cervical, and endometrial cancer when other imaging results are ambiguous.
- Detection of ovarian cancer recurrence in patients with elevated CA-125 levels and negative/ambiguous results from other imaging tests.
- Initial staging in locally advanced breast cancer (stage III) and particularly in inflammatory cancer.
- Detection of recurrence (local or distant) of breast cancer when conventional imaging findings are ambiguous.
- Detection of estrogen receptor (ER) positive lesions as a complement to biopsy in patients with recurrent or metastatic breast cancer. Examination with 18F-fluoroestradiol (FES).
PENILE CANCER
Staging in surgical candidates with suspicious findings in conventional imaging.
BLADDER CANCER
Monitoring for recurrence in patients with suspicious findings in conventional imaging.
TESTICULAR CANCER
Staging in surgical candidates with suspicious findings in conventional imaging.
BLADDER CANCER
Monitoring for recurrence in patients with suspicious findings in conventional imaging.
TESTICULAR CANCER
- Suspected recurrence of metastatic seminoma with elevated tumor markers and negative or ambiguous results from other imaging tests.
- Investigation of residual masses after treatment in patients with metastatic seminoma.
- Detection of recurrence in patients with rapidly rising PSA levels and negative or ambiguous findings in conventional imaging. Examination with PSMA (F18-PSMA or Ga68-PSMA).
- For preoperative staging of high-risk patients with ambiguous findings in conventional imaging. Examination with PSMA.
High-grade sarcomas (Ewing's sarcoma, rhabdomyosarcoma, leiomyosarcoma, osteosarcoma, malignant fibrous histiocytoma, synovial sarcoma, myxoid liposarcoma). Initial staging for detection of metastases and in suspected recurrence.
- Search for primary tumor if it will affect therapeutic decisions.
- Undiagnosed mediastinal lymphadenopathy before invasive diagnosis (mediastinoscopy, EBUS).
- Generalized lymph node involvement or strong suspicion of neoplastic disease (before biopsy).
- Search for primary neoplasm in patients with suspected paraneoplastic syndrome.
- Assessment of patients with solitary plasmacytoma to exclude multiple myeloma.
- Initial assessment of patients with oligo- or non-secretory multiple myeloma when PET/CT will be used to monitor treatment response.
- Monitoring treatment response or suspected recurrence in patients with oligo- or non-secretory multiple myeloma, extramedullary disease, or solitary plasmacytoma.
The above indications refer to the use of 18F-FDG PET/CT examination with the exception of:
- Prostate cancer, which is examined using 18F-PSMA
- Detection of estrogen receptor (ER) expression using 18F-fluoroestradiol (FES) in ER+ recurrent or metastatic breast cancer
- Well-differentiated neuroendocrine tumors. Examination with Ga68 or Cu64-DOTA peptides
- Medullary thyroid carcinoma, when recurrence is suspected. Examination with 18F-DOPA
