Clinical Indications for PET/CT
The following guidance is based on “Making the best use of clinical radiology services” published by the Royal College of Radiologists in 2007.
At present there are a number of indications for the use of PET/CT which are described below.
New PET/CT indications may develop and cancer networks will wish to expand the use of PET/CT. InHealth will respond to requests for additional scans through the cancer network.
Local cancer networks may have local indications. Local indications can be viewed using the links on the right.
| Clinical/diagnostic problem |
Recommendation (grade) |
Comment | Mouth and pharynx- Staging of oral cancer | Specialised investigation [C] | Used to identify recurrent local and distant disease in previously treated patients. |
|---|---|---|
| Parotid- Staging | Specialised investigation [C] | May have a role in staging tumours because it will identify metastases in normal-sized lymph node. |
| Larynx-Staging of laryngeal tumours | Specialised investigation [C] | Determination of gross tumour volume at presentation and to identify recurrent disease in previously treated patients. |
| Lung- Staging | Indicated only in specific circumstances [A] | PET/CT improves the diagnostic accuracy of preoperative staging in non-small-cell lung cancer. PET/CT should be considered in all patients before an attempt at surgical resection or radical oncology. |
| Oesophagus- Staging | Specialised investigation [C] | There is evidence that PET/CT is more sensitive than CT alone for detection of distant metastases diagnosis, and in the detection of residual or recurrent disease after surgical or other treatment. Accurate staging affects not only the surgical approach but also the use of other treatment, such as chemotherapy and radiotherapy, in the neoadjuvant setting. |
| Liver - secondary lesion-diagnosis | Specialised investigation [C] | PET/CT is indicated when other imaging is equivocal, and can detect extrahepatic disease when surgical resection of liver metastasis is being considered. |
| Pancreas-Staging | Specialised investigation [B] | PET/CT may be of use in equivocal cases for distant staging, where there is significant possibility of metastatic disease and resection is being considered. |
| Colon and rectum- Staging | Specialised investigation [B] | PET/CT is used increasingly in patients who are candidates for resection of hepatic and pulmonary metastases. |
| Colon and rectum- Follow-up | Indicated | PET/CT is a sensitive method of detecting local and peritoneal recurrence of rectal and colonic tumours. It is useful especially when a rising tumour marker is detected but initial imaging is normal. |
| Kidney-Staging | Indicated only in specific circumstances [B] | PET/CT offers no advantage in T staging but may be helpful if CT/MRI is inconclusive for metastases. |
| Bladder-Staging | Specialised investigation [C] | PET/CT may be used for complex problems after discussion with an MDT. |
| Testicle-Follow-up | Specialised investigation [B] | When a marker rises after treatment, FDG-PET may be helpful in identifying the site of the relapse. In the presence of a residual mass, FDG uptake may be useful in indicating the presence of a persistent or recurrent tumour. |
| Ovary-Staging | Specialised investigation [C] | PET/CT is indicated in difficult management situations, and in the assessment of distant or local spread. |
| Ovary-Follow-up | Specialised investigation [B] | PET/CT is useful when concentration of CA125 is increasing but when CT and/or MRI are normal or inconclusive. |
| Uterus: Cervix-Staging | Specialised investigation [C] | PET/CT for the detection of lymph node metastases in clinical early stage cervical cancer is being assessed. |
| Lymphoma - Staging | Specialised investigation [B] | PET/CT may be used for the initial staging if follow-up with PET/CT is planned. |
| Lymphoma- Follow-up | Specialised investigation [B] | There is evidence that PET/CT can be used from interval assessment during therapy to predict outcome. It is also useful in the assessment of residual masses. |
| Musculoskeletal tumours- Diagnosis | Specialised investigation [C] | PET/CT has a role in establishing the grade of malignancy and in directing biopsy. |
| Musculoskeletal tumours-Staging | Specialised investigation [C] | PET/CT is sensitive in the detection of metastases. |
| Metastases from unknown primary- Diagnosis | Specialised investigation [C] | PET/CT is a sensitive method for detecting primary tumours, and is widely used in head and neck and thoracic malignancy. Some centres use MRI. |
Additional Clinical Indications for PET/CT for cancer patients
The following guidance is based on the UK PET/CT advisory board September 2006.
| Clinical/diagnostic problem | Recommendation (grade) | Comment |
|---|---|---|
| Brain and spinal cord | Indicated [B] | Benign versus malignant lesions, where there is uncertainty on anatomical imaging and a relative contraindication to biopsy. |
| Brain and spinal cord | Specialised investigation [C] | Investigation of the extent of tumour within the brain or spinal cord. |
| Oropharynx | Indicated [B] | Identify tumour recurrence in previously treated carcinoma. |
| Oropharynx | Indicated [C] | Identify extent of the primary disease. |
| Thyroid | Indicated [B] | Assessment of patients with elevated thyroglobulin and negative iodine scans for recurrent disease. |
| Skin tumours | Indicated [B] | Malignant melanoma with known dissemination to assess extent of disease. |
| Skin tumours | Indicated [C] | Malignant melanoma in whom a sentinel node biopsy was not or cannot be performed in stage II (AJCC updated classification). |
Regional Clinical Indications
Click on a link below to download indications for your local area
Find out more about the NHS PET/CT South Service, including:
• How the service works
• Our mobile scanning units
• Our clinical team