Inappropriate use of oncological ¹⁸F-FDG PET/CT scans: A cross-sectional analysis of prevalence and associated...

To examine the prevalence of inappropriate ¹⁸F-FDG PET/CT use in oncological patients and associated factors.

We analyzed 900 oncological ¹⁸F-FDG PET/CT scans that were performed between July 1 to December 31, 2022 in West China Hospital, China. The appropriateness of ¹⁸F-FDG PET/CT use was assessed by two nuclear medicine experts independently using the NCCN guidelines as the reference. We performed univariate and multivariate logistic regression analyses to examine the association between predefined factors and inappropriate ¹⁸F-FDG PET/CT use.

The use of 29.8 % ¹⁸F-FDG PET/CT oncological scans was potentially inappropriate. Multivariable analysis found that having cancers located in the genitourinary system (OR 37.1, 95 % CI 16.9 to 81.3) and the digestive system (OR 23.0, 95 % CI 11.2 to 47.0) generated higher odds of potentially inappropriate ¹⁸F-FDG PET/CT use, comparing to those in the circulatory system. Patients imaged for the purpose of diagnosis (OR 4.0, 95 % CI 2.2 to 7.1) or others (a combination of follow-up and searching for primary disease; OR 68.9, 95 % CI 23.7 to 200.2) generated higher odds of potentially inappropriate use, comparing to screening. Age and gender of patients, inpatient or outpatient setting, and specialty of scan prescribing physician were not significantly associated with inappropriate ¹⁸F-FDG PET/CT use.

Potentially inappropriate ¹⁸F-FDG PET/CT use was observed in real-world practice. The site of cancer and purpose of imaging was associated with inappropriate practice, particularly in indications with insufficient evidence. Developing high-quality evidence and guideline recommendations might be helpful to promote high-value imaging.