Authors' objectives: The objective of the present report was to define criteria for appropriate use of FDG-PET for patients with lung cancer. The criteria reported in this document are to be intended as guidance for programs of clinical governance aimed at: - supporting clinicians on the use of FDG-PET in lung cancer; - post hoc analyses of appropriate use of FDG-PET; - contributing to the planning of the regional health service. The purpose of this report is not to produce clinical recommendations for the use of FDG-PET in lung cancer.

Authors' recommendations: Aim: The criteria reported in this document are to be intended as guidance for programs of clinical governance aimed at: supporting clinicians on the use of FDG-PET; post hoc analyses of appropriate use of FDG-PET; contributing to the planning of the regional health service. Method: A panel of 20 experts, comprising nuclear physicians, radiologists, radiotherapists, surgeons, oncologists, pneumologists, haematologists and health directors working in health trusts and teaching hospital of Emilia-Romagna was convened to discuss and agree on the methodology for a research program aimed at defining the criteria for appropriate use of FDG-PET in lung cancer. For each indication a systematic review was performed. The GRADE approach was applied to assess the quality of included studies, the level of confidence in the overall evidence for each outcome of interest. The GRADE approach for diagnostic recommendations was also used to elicit judgement from the panel members on benefit and harms trade-off for patient-important outcomes. The RAND method was used to vote and reach an agreement on the appropriateness criteria. Results: The panel examined and assessed the role of FDG-PET for the following 11 clinical indications: characterization of solitary pulmonary nodules ≥1 cm; staging of patients with non-small cell lung cancer (NSCLC); staging of patients with bronchioloalveolar cancer (BAC); staging of patients with small cell lung cancer (SCLC); target volume definition of radiation treatment with curative intent in patients treated for lung cancer ; during-treatment evaluation of early response to neo-adjuvant therapy in patients treated for NSCLC; during-treatment evaluation of early response to neo-adjuvant therapy in patients treated for SCLC; end of treatment evaluation of response to neo-adjuvant therapy in patients treated for NSCLC; end of treatment evaluation of response to systemic therapy in patients treated fot SCLC; follow up of patients treated for NSCLC with no suspicion of recurrence; diagnosis and staging of suspected loco-regional recurrence in patients treated for NSCLC. One hundred and fourteen studies were included. All retrieved studies evaluated diagnostic accuracy of FDG-PET, and no studies evaluating the impact of FDG-PET on clinical outcomes were found. Recommendations: Criteria for appropriate use of FDG-PET in head and neck cancer : characterization of solitary pulmonary nodules ≥1 cm - Appropriate (level of evidence: moderate); staging of patients with NSCLC - Appropriate (level of evidence: moderate) ; staging of patients with BAC - Inappropriate for lack of diagnostic role of FDG-PET ; staging of patients with SCLC - Uncertain (level of evidence: very low) ; target volume definition of radiation treatment with curative intent in patients treated for lung cancer - Uncertain (level of evidence: very low) ; during-treatment evaluation of early response to neo-adjuvant therapy in patients treated for NSCLC - Inappropriate for lack of diagnostic role of FDG-PET ; during-treatment evaluation of early response to neo-adjuvant therapy in patients treated for SCLC - Inappropriate for lack of diagnostic role of FDG-PET ; end of treatment evaluation of response to neo-adjuvant therapy in patients treated for NSCLC - Uncertain (level of evidence: very low); end of treatment evaluation of response to systemic therapy in patients treated for SCLC - Inappropriate for lack of diagnostic role of FDG-PET ; follow up of patients treated for NSCLC with no suspicion of recurrence - Inappropriate for lack of diagnostic role of FDG-PET ; diagnosis and staging of suspected loco-regional recurrence in patients treated for NSCLC - Uncertain (level of evidence: very low).

Project Status: Completed

Year Published: 2012

URL for published report: http://assr.regione.emilia-romagna.it/it/servizi/pubblicazioni/dossier/doss219

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Italy

Organisation Name: Agenzia Sanitaria e Sociale Regionale (Regional Agency for Health and Social Care)

Contact Address: Viale Aldo Moro 21, 40127 Bologna, Italia tel. +39 051 5277177 fax +39 051 5277049

Contact Name: Ballini_Lu@regione.emilia-romagna.it

Contact Email: Ballini_Lu@regione.emilia-romagna.it

Copyright: Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna