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 25 experts working in Health Trusts and Teaching Hospitals 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 oncology. 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: For each disease the panel examined and assessed the role of FDG-PET for the following 6 clinical indications (for a total of 12 clinical questions: staging; dose painting definition in involved-field radiation treatment; during treatment evaluation of early response to therapy; end of treatment evaluation of response to therapy; follow up of patients with no suspicion of recurrence; staging of recurrence). Nine systematic reviews and 33 primary studies, evaluating diagnostic accuracy of FDG-PET, were included. Recommendations: Criteria for the appropriate use of FDG-PET in Hodgkin's lymphoma: Staging: Appropriate (level of evidence: moderate); Dose painting definition in involved-field radiation treatment: Indeterminate due to lack of studies; During treatment evaluation of early response to therapy: Appropriate (level of evidence: moderate); End of treatment evaluation of response to therapy: Appropriate (level of evidence: moderate); Follow up of treated patients, with no suspicion of recurrence: Inappropriate (level of evidence: low): Staging of recurrence in treated patients: Appropriate (level of evidence: very low). Criteria for the appropriate use of FDG-PET in aggressive non-Hodgkin's lymphoma: Staging: Appropriate (level of evidence: moderate); Dose painting definition in involved-field radiation treatment: Indeterminate due to lack of studies; During treatment evaluation of early response to therapy: Inappropriate (level of evidence: moderate); End of treatment evaluation of response to therapy: Appropriate (level of evidence: moderate); Follow up of treated patients, with no suspicion of recurrence: Inappropriate (level of evidence: very low); Staging of recurrence in treated patients: Appropriate (level of evidence: very low). For all the above clinical indications the panel reached an agreement.

Project Status: Completed

Year Published: 2012

URL for published report: http://assr.regione.emilia-romagna.it/it/servizi/pubblicazioni/dossier/doss227

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