Authors' objectives:

This report reviews the available evidence on the safety, effectiveness and cost-effectiveness of positron emission tomography (PET).

Authors' results and conclusions: Safety: It is generally accepted that PET is a noninvasive and relatively safe diagnostic procedure. Safety issues are primarily discussed in terms of the safety of the positron-emitting radiopharmaceutical, rather than the safety of the procedure as a whole. In a large study of 22 FDG PET centres in the United States no adverse reactions to positron-emitting radiopharmaceuticals were reported for 33,295 retrospective doses of positron-emitting radiopharmaceuticals from before 1994 or 47,876 prospective doses from 1994 to 1997. The United States Pharmacopoeia (USP) drug information for FDG also indicates that there are no known adverse effects associated with the use of FDG. In addition, radiotracers are generally used in microgram quantities, and the incidence of adverse reactions to very small amounts of labelled molecules is likely to continue to be low. Effectiveness: PET has improved diagnostic accuracy over conventional imaging in a number of indications. It has been shown to increase the detection of mediastinal and distant metastases not detected by conventional imaging in the staging of SCLC. It also has increased sensitivity in detecting metastatic disease in patients with melanoma or CRC who are being considered for surgical resection. However, it still has low sensitivity for detecting early microscopic etastatic disease, which is also the case for other widely available diagnostic technologies. PET can probably also detect viable myocardium that may respond to reperfusion and seems more sensitive and specific than imaging with single photon emission computed tomography (SPECT). The reported sensitivity of PET in medically refractory epilepsy is also relatively high. In each of these examples, PET has demonstrated improvement in diagnostic accuracy, but the degree of improvement is difficult to quantify because of limitations of the study designs, specifically, the way in which cases were selected for studies, the way in which tests were selected for patients, and the way in which appropriate reference standards were selected for comparison.

Authors' recommendations: MSAC concludes that: - there is insufficient evidence at this time from which to draw definitive conclusions about the clinical effectiveness and cost-effectiveness of FDG PET; - in most indications, FDG PET is used in addition to other diagnostic modalities (and this was the case in the diagnostic algorithm used for the current assessment); - in terms of adverse patient reaction to administration of FDG, FDG PET is safe; and - further evaluation of the technology is necessary.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/reports.htm

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee