Description
Positron emission tomography (PET) scans are based on the use of positron-emitting radionuclide tracers coupled to organic molecules, such as glucose, ammonia, or water. The radionuclide tracers simultaneously emit two (2) high-energy photons in opposite directions that can be simultaneously detected (referred to as coincidence detection) by a PET scanner, comprising multiple stationary detectors that encircle the area of interest.
The utility of PET scanning for the diagnosis, staging and restaging, and surveillance of malignancies varies by type of cancer. In general, PET scanning can distinguish benign from malignant masses in certain circumstances and improve the accuracy of staging by detecting additional disease not detected by other imaging modalities. Therefore, PET scanning for diagnosis and staging of malignancies can be considered medically necessary when specific criteria are met for specific cancers, as outlined in the policy statements. For follow-up after initial diagnosis and staging have been performed, there are a few situations in which PET can improve detection of recurrence, and lead to changes in management that improve the net health outcome.
Summary of Evidence
Bladder Cancer
For individuals who have suspected or diagnosed bladder cancer in need of staging or restaging information who receive fluorine 18 ( 18 F) coupled with fluorodeoxyglucose (FDG) PET or FDG-PET/computed tomography (CT), the evidence includes a systematic review and meta-analysis. Relevant outcome is test validity. Pooled analyses showed relatively high sensitivity and specificity for muscle-invasive bladder cancer. Clinical guidelines include PET and PET/CT as considerations in staging muscle-invasive bladder cancer, though CT, magnetic resonance imaging, and chest radiographs are also appropriate techniques for staging purposes. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing bladder cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Bone Sarcoma
For individuals who have suspected or diagnosed bone sarcoma and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes systematic reviews and meta-analyses. Relevant outcome is test validity. Pooled analyses have shown that PET or PET/CT can effectively diagnose and stage bone sarcoma, including chondrosarcoma. Use of PET or PET/CT has high sensitivities and specificities in detecting metastases in bone and lymph nodes; however, the tests have low sensitivity in detecting lung metastases. Clinical guidelines include PET and CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing bone sarcoma treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Brain Tumors
For individuals who have diagnosed brain tumors and in need of staging or restaging information or who have suspected brain tumor who receive FDG-PET, 18 F fluoro-ethyl-tyrosine PET, or carbon 11 ( 11 C) methionine PET, the evidence includes several systematic reviews and meta-analyses. Relevant outcome is test validity. Pooled analyses have shown that PET or PET/CT can be effective in distinguishing brain tumors from normal tissue. Indirect comparisons between the radiotracers 11 C-methionine and FDG have shown that 11 C-methionine may have better diagnostic performance. Clinical guidelines include PET to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing brain cancer treatment who receive FDG-PET, 18 F fluoro-ethyl-tyrosine-PET, or 11 C-methionine PET, the evidence includes systematic reviews and meta-analyses. Relevant outcome is test validity. Pooled analyses did not support the use of PET for surveillance of brain cancer following treatment. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Breast Cancer
For individuals who have diagnosed breast cancer and inconclusive results from other imaging techniques who receive adjunctive FDG-PET or FDG-PET/CT for staging or restaging, the evidence includes meta-analyses. Relevant outcome is test validity. While studies included in the meta-analyses reported variability in estimates of sensitivity and specificity, FDG-PET or FDG-PET/CT may be helpful in situations in which standard staging results are equivocal or suspicious, particularly in individuals with locally advanced or metastatic disease. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected or diagnosed breast cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a TEC Assessment, several systematic reviews, and meta-analyses. Relevant outcome is test validity. There is no evidence supporting the use of PET in diagnosing breast cancer. The false-negative rates (5.5% to 8.5%) using PET in individuals with breast cancer can be considered unacceptable, given that breast biopsy can provide more definitive results. Use of PET/CT may be considered for the detection of metastases only when results from other imaging techniques are inconclusive. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing breast cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Cervical Cancer
For individuals who have diagnosed cervical cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes an Agency for Healthcare Research and Quality (AHRQ) report and meta-analyses. Relevant outcome is test validity. Pooled results have shown that PET can be used for staging or restaging and for detecting recurrent disease. Clinical guidelines include PET and CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected cervical cancer or who are asymptomatic after completing cervical cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcomes are test accuracy and test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Colorectal Cancer
For individuals who have diagnosed colorectal cancer (CRC) and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes several meta-analyses. Relevant outcome is test validity. A meta-analysis evaluating the diagnostic accuracy of PET or PET/CT found a high sensitivity but low specificity. Several pooled analyses evaluating staging or restaging using PET or PET/CT resulted in wide ranges of sensitivities and specificities, from 16% to 99%. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected CRC or who are asymptomatic after completing CRC treatment who receive FDG-PET or FDG-PET/CT, the evidence includes a randomized controlled trial (RCT). Relevant outcome is test validity. The RCT found no differences in outcomes when FDG-PET/CT was added to usual surveillance compared to usual surveillance only. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Endometrial Cancer
For individuals who have diagnosed endometrial cancer in need of staging or restaging information or who are asymptomatic after completing endometrial cancer treatment who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review and meta-analysis. Relevant outcome is test validity. Pooled estimates from the meta-analysis showed high sensitivities and specificities for FDG-PET/CT in detecting lymph node metastases and endometrial cancer recurrence following treatment. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
Esophageal Cancer
For individuals who have diagnosed esophageal cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes several meta-analyses. Relevant outcome is test validity. Pooled estimates have shown high sensitivities and specificities compared to other diagnostic imaging techniques. Clinical guidelines include PET and CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected esophageal cancer or who are asymptomatic after completing esophageal cancer treatment who receive FDG-PET or FDG-PET/CT, the evidence includes meta-analyses. Relevant outcome is test validity. Pooled analyses have shown adequate sensitivities but low specificities. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Gastric Cancer
For individuals who have suspected or diagnosed gastric cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes several meta-analyses. Relevant outcome is test validity. Pooled analyses, with sensitivities and specificities ranging from 78% to 88%, have shown that PET or PET/CT can inform staging or restaging of individuals with gastric cancer. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing gastric cancer treatment who receive FDG-PET or FDG-PET/CT, the evidence includes meta-analyses. Relevant outcome is test validity. Pooled analyses have shown low sensitivities and specificities. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Head and Neck Cancer
For individuals who have suspected or diagnosed head and neck cancer in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes several systematic reviews and meta-analyses. Relevant outcome is test validity. In individuals with head and neck cancers, PET and PET/CT are better able to detect local and metastatic disease compared with other imaging techniques. Evidence has also shown that FDG-PET/CT may be useful in predicting response to therapy. Two meta-analyses calculated the ability of FDG-PET or PET/CT to detect the residual or recurrent disease during various stages of treatment and another meta-analysis calculated the ability of positive PET or PET/CT results to predict overall survival and event-free survival. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing head and neck cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Non-Small-Cell Lung Cancer
For individuals who have suspected non-small-cell lung cancer (NSCLC) and inconclusive results from other imaging techniques or who have diagnosed NSCLC and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes several meta-analyses. Relevant outcome is test validity. Pooled analyses have shown that PET and PET/CT have better diagnostic performance than conventional imaging techniques. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected NSCLC or who are asymptomatic after completing NSCLC treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Small-Cell Lung Cancer
For individuals with diagnosed small-cell lung cancer (SCLC) and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes systematic reviews and meta-analyse s. Relevant outcome is test validity. While the quality of the studies was considered low, PET and PET/CT can be considered for staging or restaging in individuals with SCLC if a limited stage is suspected. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected SCLC or who are asymptomatic after completing SCLC treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcomes are test accuracy and test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Hodgkin and Non-Hodgkin Lymphoma
For individuals who have suspected or diagnosed Hodgkin and non-Hodgkin lymphoma in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a TEC Assessment, several meta-analyses, and a RCT. Relevant outcome is test validity. Both PET and PET/CT have been found to provide useful information in the management of Hodgkin and non-Hodgkin lymphoma. The Deauville 5-point scale was developed based on PET results and can be used for staging and treatment response for individuals with lymphoma. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing Hodgkin lymphoma treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing non-Hodgkin lymphoma treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Melanoma
For individuals who have suspected or diagnosed stage I or II melanoma and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a TEC Assessment. Relevant outcome is test validity. Evidence has shown PET and PET/CT are not as beneficial as the reference standard (sentinel node biopsy) for assessing regional lymph nodes. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have diagnosed advanced melanoma (stage III or IV) and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a TEC Assessment and a meta-analysis. Relevant outcome is test validity. Evidence has shown PET and PET/CT can detect systemic metastases in individuals with advanced melanoma. Clinical guidelines include PET/CT for staging or restaging stage III or IV disease and for surveillance. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing melanoma treatment who receive FDG-PET or FDG-PET/CT, the evidence includes retrospective and observational studies. Relevant outcome is test validity. At the discretion of the physician, imaging surveillance can be considered every three (3) to 12 months. Because recurrences usually occur within three (3) years, screening asymptomatic individuals beyond three (3) to five (5) years is not recommended. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
Multiple Myeloma
For individuals who have suspected or diagnosed multiple myeloma in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes systematic reviews and a prospective, comparative study. Relevant outcome is test validity. The meta-analysis reported high sensitivity in detecting extramedullary lesions in individuals with multiple myeloma. The sensitivity of FDG-PET was greater than whole body x-ray in a meta-analysis and was similar to whole-body MRI, with MRI having a higher sensitivity for detecting skull and spine bone lesions, in a prospective evaluation. Clinical guidelines include PET/CT on the list of imaging techniques that may be useful for initial workup, as well as follow-up and surveillance as indicated. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing multiple myeloma treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Neuroendocrine Tumors
For individuals who have suspected or diagnosed neuroendocrine tumors and in need of staging or restaging information or who are asymptomatic after completing neuroendocrine tumor treatment who receive FDG-PET or FDG-PET/CT, the evidence includes two (2) meta-analyses. Relevant outcome is test validity. The evidence did not compare PET or PET/CT with other modalities and, therefore, did not provide comparative effectiveness information. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected or diagnosed neuroendocrine tumors and in need of staging or restaging information who receive gallium 68 ( 68 Ga) or copper 64 ( 64 Cu) PET or PET/CT , the evidence includes several systematic reviews with meta-analyses and prospective, comparative studies. Relevant outcome is test validity. The meta-analyses showed relatively high sensitivities and specificities using 68 Ga-PET/CT as the radiotracer compared with other imaging techniques in the diagnosis and staging of neuroendocrine tumors. A study comparing the diagnostic performance between 64 Cu PET/CT and 68 Ga-PET/CT reported an increase in detection of lesions with 64 Cu PET/CT. Current guidelines recommend using somatostatin receptor PET tracers, 68 Ga-dotatate, 68 Ga-dotatoc, or 64 Cu-dotatate, to assess receptor status and presence of distant disease. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing neuroendocrine tumor treatment who receive 68 Ga or 64 Cu PET or PET/CT , there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Ovarian Cancer
For individuals who have diagnosed ovarian cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes an AHRQ systematic review and several meta-analyses. Relevant outcome is test validity. Pooled sensitivities and specificities have supported the use of PET and PET/CT for the detection of recurrent ovarian cancer. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected ovarian cancer or who are asymptomatic after completing ovarian cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Pancreatic Cancer
For individuals who have suspected or diagnosed pancreatic cancer and with inconclusive results from other imaging techniques who receive adjunctive FDG-PET or FDG-PET/CT for staging or restaging, the evidence includes a TEC Assessment, systematic reviews, and a large observational study. Relevant outcome is test validity. The evidence has shown that PET and PET/CT do not have a high enough negative predictive value to surpass current standard decision thresholds. The large observational study, which assessed the incremental diagnostic value of PET/CT when added to standard workup with CT, showed significant improvements in sensitivity and specificity compared with CT alone. Clinical guidelines state that PET or PET/CT should only be considered if the results from standard staging methods are inconclusive. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected or diagnosed pancreatic cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes an AHRQ systematic review, a TEC Assessment, and a meta-analysis published after the review and assessment. Relevant outcome is test validity. The evidence has shown that PET and PET/CT do not have a high enough negative predictive value to surpass current standard decision thresholds. Therefore, PET or PET/CT should only be considered if the results from standard staging methods are inconclusive. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing pancreatic cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Penile Cancer
For individuals who have suspected or diagnosed node negative penile cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review. Relevant outcome is test validity. The evidence has shown that PET had a low sensitivity, and no comparisons were made with other modalities. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected or diagnosed node positive penile cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review and a retrospective comparative study. Relevant outcome is test validity. In individuals with suspected inguinal lymph node positive disease, PET/CT may offer increased sensitivity compared to CT alone for staging. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing penile cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Prostate Cancer
For individuals who have suspected or diagnosed prostate cancer and in need of staging or restaging information who receive 11 C-choline PET, 11 C-choline PET/CT, 18 F-fluciclovine PET, or 18 F-fluciclovine PET/CT, the evidence includes several meta-analyses. Relevant outcome is test validity. Meta-analyses have reported that use of 11 C-choline and 18 F-fluciclovine radiotracers result in similar sensitivities and specificities. Prospective studies in men with biochemical recurrence after primary treatment have reported that a majority of management decisions were changed based on 18 F-fluciclovine PET/CT results among men with suspected recurrence. One of those studies evaluated the impact on clinical outcomes and reported an increase in 3-year event-free survival rates. Further study is needed to compare PET and PET/CT with other imaging techniques, such as MRI and radionuclide bone scan. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing prostate cancer treatment who receive 11 C-choline PET, 11 C-choline PET/CT, 18 F-fluciclovine PET, or 18 F-fluciclovine PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected prostate cancer who receive 68 Ga-prostate-specific membrane antigen (PSMA) PET, 68 Ga-PSMA PET/CT, piflufolastat-F 18 PET, and piflufolastat-F 18 PET/CT, the evidence includes a systematic review. Relevant outcome is test validity. The systematic review found similar diagnostic accuracy for PSMA PET and MRI for detection of clinically significant prostate cancer, but evidence was too limited to draw conclusions as only 3 studies of 228 individuals were included in the analysis. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have diagnosed prostate cancer and in need of staging or restaging information who receive 68 Ga-prostate-specific membrane antigen (PSMA) PET, 68 Ga-PSMA PET/CT, piflufolastat-F 18 PET, and piflufolastat-F 18 PET/CT, the evidence includes systematic reviews and prospective, multicenter trials. Relevant outcome is test validity. Systematic reviews have found PSMA PET to have similar diagnostic accuracy across prostate cancer risk groups in newly diagnosed individuals, and to be similar to MRI for staging intermediate/high-risk prostate cancer. Systematic reviews of studies conducted in individuals with biochemical recurrence found high proportions with positive PSMA PET imaging, often leading to change in management. Individual prospective trials have generally found that PSMA PET provides a high specificity for detecting pelvic lymph node or distant metastases in newly diagnosed individuals with high-risk disease and a clinically relevant PPV in individuals with biochemical recurrence. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who are asymptomatic after completing prostate cancer treatment who receive 68 Ga-PSMA PET, 68 Ga-PSMA PET/CT, piflufolastat-F 18 PET, and piflufolastat-F 18 PET/CT, there is no evidence on clinical outcomes. Relevant outcome that has been studied is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Renal Cell Carcinoma
For individuals who are diagnosed with renal cell carcinoma and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review and meta-analysis. Relevant outcome is test validity. The review concluded that PET has the potential to detect metastatic or recurrent lesions in individuals with renal cell cancer but that additional prospective studies are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Soft Tissue Sarcoma
For individuals who have diagnosed soft tissue sarcoma and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes an AHRQ review and a systematic review using PET for assessing response to imatinib. Relevant outcome is test validity. The review reported that PET had low diagnostic accuracy and there was a lack of studies comparing PET with alternative diagnostic modalities. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals with diagnosed soft tissue sarcoma and in need of rapid reading of response to imatinib treatment who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review. Relevant outcome is test validity. The review concluded that PET/CT can be used to monitor treatment response to imatinib, which can lead to individually adapted treatment strategies. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected soft tissue sarcoma or who are asymptomatic after completing soft tissue sarcoma treatment who receive FDG-PET or FDG-PET/CT, the evidence includes a systematic review. Relevant outcome is test validity. The review concluded that there was insufficient evidence on the use of PET for the detection of locoregional recurrence. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Testicular Cancer
For individuals with diagnosed testicular cancer in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes an AHRQ systematic review and assessment. Relevant outcome is test validity. Results have shown that PET or PET/CT can evaluate residual masses following chemotherapy for seminoma. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. There is no evidence supporting the use of PET or PET/CT in nonseminoma individuals. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected testicular cancer or who are asymptomatic after completing testicular cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Thyroid Cancer
For individuals with diagnosed thyroid cancer and in need of staging or restaging information who receive FDG-PET or FDG-PET/CT, the evidence includes systematic reviews and meta-analyses. Relevant outcome is test validity. Pooled analyses have shown that PET or PET/CT can effectively detect recurrent differentiated thyroid cancer. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have suspected thyroid cancer or who are asymptomatic after completing thyroid cancer treatment who receive FDG-PET or FDG-PET/CT, there is no evidence. Relevant outcome is test validity. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Cancer of Unknown Primary and Single-Site Metastatic Disease
For individuals with cancer of unknown primary and single-site metastatic disease who receive FDG-PET or FDG-PET/CT, the evidence includes a TEC Assessment. Relevant outcome is test validity. Studies reviewed in the assessment showed that PET identified previously undetected metastases confirmed by biopsy. Additionally, PET can contribute to the management of individuals with cancer of unknown primary. Clinical guidelines include PET/CT to inform management decisions that may offer clinical benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.
