[Positron emission tomography in oncology: an update]

Area of Science:

• Oncology
• Nuclear Medicine
• Radiochemistry

Context:

• Positron emission tomography (PET) is extensively utilized in oncology for staging and evaluating treatment response.
• The radiotracer [18F]-fluorodeoxyglucose ([18F]-FDG) is the most common agent used in these applications.
• Despite its widespread use, a critical review of its role in routine patient care is warranted.

Purpose:

• To critically evaluate the current role of PET imaging in routine oncological patient care.
• To discuss the advantages and limitations of [18F]-FDG PET, particularly regarding its sensitivity and specificity.
• To emphasize the importance of appropriate patient selection and expert image interpretation.

Summary:

• [18F]-FDG PET offers high sensitivity for cancer detection, aided by its favorable radiotracer properties like a 110-minute half-life and ease of production.
• However, its specificity is limited, as infectious and inflammatory conditions can mimic malignancies, potentially leading to false positives.
• Minimizing false positives requires careful patient selection, adherence to recommended indications, and interpretation by experienced teams with access to clinical and ancillary diagnostic data.

Impact:

• PET imaging, while accurate, is not universally required for all cancer patients; conventional imaging has also seen significant advancements.
• Effective utilization of PET requires avoiding lengthy waiting lists to prevent treatment delays that could negate the benefits of the imaging modality.
• Optimizing the use of PET in oncology necessitates a balanced approach, considering its benefits against potential drawbacks and resource availability.