Athens Medical Group | PET/CT indications approved by EOPYY

PET/CT indications approved by EOPYY

1. LUNG CANCER

Solitary Pulmonary Nodule:

Small Cell and Non-Small Cell Lung Cancer:

  • Staging of patients with limited disease on conventional imaging who are considered candidates for radical treatment.
  • Restaging of patients with non-small cell lung cancer following concurrent chemoradiotherapy.
  • Investigation of suspected recurrence of non-small cell lung cancer – differential diagnosis between recurrence and post-treatment changes.

Mesothelioma

  • Pleural thickening suspicious for malignancy, to determine the appropriate biopsy site.
  • Confirmed mesothelioma, to exclude extrathoracic disease in patients who are candidates for radical surgical treatment.

Thymic Tumors

  • Staging of patients with malignant thymic neoplasms who are candidates for radical surgical treatment.

2. HODGKIN DISEASE & NON-HODGKIN LYMPHOMAS

  • Initial staging of Hodgkin and non-Hodgkin lymphomas.
  • Early assessment after 2–3 cycles of chemotherapy (interim PET/CT) in selected patients with Hodgkin lymphoma, when the results are expected to influence treatment decisions.
  • Reassessment of Hodgkin and non-Hodgkin lymphomas (subtypes with known 18F-FDG uptake) following completion of treatment, to investigate residual disease.
  • Investigation of suspected recurrence of Hodgkin and non-Hodgkin lymphoma.
  • Suspected transformation of low-grade lymphoma or chronic lymphocytic leukemia into high-grade lymphoma.

3. MELANOMA

  • Initial staging (for distant metastases), restaging, and assessment for recurrence in patients receiving immunotherapy and/or molecularly targeted therapy.

4. THYROID CANCER:

  • Differentiated thyroid cancer. Investigation of suspected recurrence (when the whole-body I-131 scan is negative and thyroglobulin levels are elevated).
  • Medullary thyroid carcinoma. Investigation of suspected recurrence (when calcitonin levels are elevated and other diagnostic findings are negative or inconclusive) – Assessment with 18F-FDOPA.
  • Initial staging and restaging of poorly differentiated thyroid cancer (undifferentiated carcinoma, anaplastic carcinoma, Hürthle cell carcinoma).

5. HEAD AND NECK CANCER

  • Identification of the primary tumor in patients with cervical lymph nodes involved by squamous cell carcinoma.
  • Staging.
  • Assessment of treatment response 3–6 months after chemoradiotherapy.
  • Investigation of suspected recurrence when other imaging findings are inconclusive.

6. GASTROINTESTINAL CANCER

Gastric and Esophageal Cancer:

  • Initial staging in patients who are candidates for radical surgical treatment.
  • Restaging following treatment.
  • Investigation of suspected recurrence when other imaging findings are inconclusive.

Colorectal Cancer

  • Staging prior to therapeutic metastasectomy.
  • Detection of recurrence in patients with elevated tumor markers and/or clinical suspicion, when other imaging findings are negative or inconclusive.
  • Assessment of response to targeted interventional techniques (radiofrequency ablation, chemoembolization/radioembolization) or chemoradiotherapy.

Anal Cancer

  • Initial staging, assessment of response following chemoradiotherapy, and evaluation for residual disease or recurrence.

Gastrointestinal Stromal Tumors (GIST)

  • Staging of patients who are candidates for molecularly targeted therapy.
  • Assessment of response to molecularly targeted therapy.

Liver, Biliary Tract and Pancreatic Cancer

  • Assessment of patients with known pancreatic cancer who are candidates for radical surgical treatment, when other imaging findings are negative or inconclusive for metastatic disease, and restaging following neoadjuvant treatment.
  • Investigation of suspected pancreatic cancer recurrence when conventional imaging reveals suspicious findings.
  • Assessment of patients with known cholangiocarcinoma or high-grade hepatocellular carcinoma who are candidates for radical surgical treatment or transplantation, when other imaging findings are negative or inconclusive for metastatic disease.
  • Investigation of suspected recurrence of cholangiocarcinoma or high-grade hepatocellular carcinoma when conventional imaging findings are inconclusive.
  • Assessment of response to targeted interventional techniques (radiofrequency ablation, chemoembolization/radioembolization) or chemoradiotherapy.
  • Staging/restaging and detection of recurrence in well-differentiated neuroendocrine tumors. Assessment using DOTA-labeled peptides.
  • Staging/restaging and detection of recurrence in poorly differentiated neuroendocrine tumors. Assessment using 18F-FDG.

7. GYNECOLOGICAL CANCER

  • Staging and restaging of vulvar, cervical, and endometrial cancer in patients who are candidates for radical treatment (particularly in cervical cancer, other imaging examinations should have been performed beforehand).
  • Assessment of response to chemoradiotherapy in locally advanced cervical cancer.
  • Investigation of suspected recurrence of vulvar, cervical, and endometrial cancer when other imaging findings are inconclusive.
  • Detection of ovarian cancer recurrence in patients with elevated CA-125 levels and negative or inconclusive findings on other imaging examinations.

8. BREAST CANCER

  • Initial staging of locally advanced breast cancer (stage III), particularly inflammatory breast cancer.
  • Detection of breast cancer recurrence (local or distant) when conventional imaging findings are inconclusive.

9. UROLOGICAL CANCER

Penile Cancer

  • Staging in patients who are candidates for surgical treatment and have suspicious findings on conventional imaging.

Bladder Cancer

  • Assessment for recurrence in patients with suspicious findings on conventional imaging.

Testicular Cancer

  • Investigation of suspected recurrence of metastatic seminoma in patients with elevated tumor markers and negative or inconclusive findings on other imaging examinations.
  • Evaluation of residual masses following treatment in patients with metastatic seminoma.

Prostate Cancer

  • Detection of recurrence in patients with rapidly rising PSA levels and negative or inconclusive findings on conventional imaging. Assessment using PSMA or 18F-choline.
  • Preoperative staging of high-risk patients with inconclusive findings on conventional imaging. Assessment using PSMA or 18F-choline.

10. MUSCULOSKELETAL TUMORS

  • High-grade sarcomas (Ewing sarcoma, rhabdomyosarcoma, leiomyosarcoma, osteosarcoma, malignant fibrous histiocytoma, synovial sarcoma, myxoid liposarcoma). Initial staging for the detection of metastases, as well as investigation of suspected recurrence.

11. CANCER OF UNKNOWN PRIMARY ORIGIN

  • Identification of the primary tumor when the findings are expected to influence treatment decisions.
  • Unexplained mediastinal lymphadenopathy prior to invasive diagnostic procedures (mediastinoscopy, EBUS).
  • Generalized lymph node involvement or strong suspicion of neoplastic disease (prior to biopsy).
  • Identification of a primary neoplasm in patients with suspected paraneoplastic syndrome.

12. MULTIPLE MYELOMA

  • Assessment of patients with solitary plasmacytoma to exclude multiple myeloma.
  • Initial assessment of patients with oligosecretory or nonsecretory multiple myeloma when PET/CT is intended to be used for monitoring treatment response.
  • Assessment of treatment response or suspected recurrence in patients with oligosecretory or nonsecretory multiple myeloma, extramedullary disease, or solitary plasmacytoma.

13. INVESTIGATION OF FEVER OF UNKNOWN ORIGIN

  • Investigation of fever of unknown origin when the underlying cause has not been identified through conventional imaging methods.

14. CARDIOLOGY

  • Suspected infection of vascular grafts, prosthetic heart valves, or implanted cardiac devices following inconclusive transesophageal echocardiography findings.
  • Suspected prosthetic valve endocarditis, provided that the conventional diagnostic evaluation, including other imaging examinations, has been completed.
  • Assessment of myocardial viability using 18F-FDG in patients with large (>10%) irreversible defects on myocardial perfusion scintigraphy and multivessel coronary artery disease or left main coronary artery disease, or in patients with severe/multiple comorbidities (chronic kidney disease, chronic obstructive pulmonary disease, previous CABG).
  • Sarcoidosis. Investigation of suspected cardiac involvement.

15. NEUROLOGY

Epilepsy

  • Preoperative evaluation to identify an epileptogenic focus that has not been clearly localized through clinical assessment, imaging, or electroencephalographic (EEG) findings. Patients must have drug-resistant focal epilepsy, defined as failure to achieve seizure control despite treatment with at least two appropriately selected and adequately dosed antiepileptic medications.

Dementia

  • FDG PET in degenerative dementia, for differential diagnosis between frontotemporal dementia (FTD) and Alzheimer’s disease dementia (AD). The following prerequisites must be met: a. Patients must fulfill the diagnostic criteria for both FTD and AD. b. A comprehensive clinical and diagnostic evaluation for possible causes of dementia must have been completed without establishing a definitive etiology.