[FDG PET and its impact on patient's management in oncology]

FDG, a radioactive glucose analog for PET imaging, requires some precautions: it should be used only in patients with glycemia < 7mmol/L, fasting for at least 6 h but well hydrated, and after pregnancy is ruled out. FDG-PET has many indications in oncology. Its clinical utility has been documented in some circumstances, listed as routine indications in the European Principal Characteristics Summary and the French Standards, Options, and Recommendations. The European "Points to Consider" define as a principal criterion of clinical utility the impact of the imaging results on patient management. The original results presented here evaluate the clinical impact of FDG-PET among patients at Tenon Hospital by the rate of modifications in patient' management, determined with the same questionnaire as that used in two California studies of 2044 patients. Our response rate was lower than in our previous retrospective study in 2000 (34% versus 73%), probably because a prospective evaluation requires more work by the referring physician (who had to respond to two separate letters). On the other hand, the modification rate rose significantly (54% versus 46%, p<0.001), especially for colorectal cancer (58% versus 44%, p<0.02). The California studies had similar response rates (31%-48%, depending on the indication). Their modification rates were also similar, although higher for lymphoma (68%), colorectal (65%) and breast (58%) cancers.