Objective: This study aims to develop a Clinical Practice Guide for the rational use of the Positron Emission Tomography (PET) in Oncology, that makes it possible to approach the real existence of demand in the public health care service of Andalucía, by limiting the clinical indications, using criteria based on the existence of sufficient scientific evidence on the effectiveness and clinical impact of PET.
Method: The consensus technique was used to elaborate the Guide, gathering a group of nuclear medicine experts. Prior to this a systematic research of the scientific literature was carried out, using strict criteria for the selection of the articles, such as the evaluation of the epidemiological data, work methodology, clinical and pathological diagnosis, gold standard references and statistical analysis. In each pathology group, the existence of alternative non-invasive diagnostic techniques was assessed, comparing its effectiveness and clinical impact with the PET, and the existence of useful treatments correlated with the results of the examination was also evaluated. When it was possible, we evaluated the cost-effectiveness of the PET. Finally, the cost-effectivity of the technique was assessed and the limitation of present and future resources and the economical costs arising from the PET costs and introduction were evaluated.
Results and conclusions: It was considered that the PET was indicated in the following clinical conditions: 1: Assessment of Colorectal Cancer recurrence in patients with increased levels of tumor markers and negative morphological imaging techniques. Suspicion of isolated resectable recurrence. 2: Restaging in patients with high risk melanoma. 3: Differential diagnosis of solitary pulmonary nodules. 4: Staging of non-small cell bronchial carcinoma. 5: Staging and detection of recurrences of lymphomas. 6: Restaging of head and neck cancer with possibilities of curative treatment. 7: Diagnosis of recurrences in differentiated thyroid cancer in patients with increased plasma levels of thyroglobulin and negative radioiodine scintiscan. 8: Staging and follow-up of medullary thyroid carcinoma. 9: Differential diagnosis between recurrent tumor and scar or radionecrosis in brain tumors.