PMID- 37314473 OWN - NLM STAT- MEDLINE DCOM- 20231027 LR - 20231209 IS - 1432-1084 (Electronic) IS - 0938-7994 (Linking) VI - 33 IP - 11 DP - 2023 Nov TI - Quality and consistency of clinical practice guideline recommendations for PET/CT and PET: a systematic appraisal. PG - 7879-7889 LID - 10.1007/s00330-023-09786-8 [doi] AB - OBJECTIVES: To systematically appraise the methodologies used for guidelines for positron emission tomography (PET) imaging and to compare the consistency of these recommendations. METHODS: We searched PubMed, EMBASE, four guideline databases, and Google Scholar to identify evidence-based clinical practice guidelines pertaining to the use of PET, PET/computed tomography (CT), or PET/magnetic resonance in routine practice. We assessed the quality of each guideline using the Appraisal of Guidelines for Research and Evaluation II instrument and compared recommendations regarding indications for (18)F-fluorodeoxyglucose (FDG) PET/CT. RESULTS: Thirty-five guidelines for PET imaging, published between 2008 and 2021, were included. These guidelines performed well in the domains of scope and purpose (median 80.6%, inter-quartile range [IQR] 77.8-83.3%) and clarity of presentation (median 75%, IQR 69.4-83.3%), but poorly in applicability (median 27.1%, IQR 22.9-37.5%). Recommendations for 48 indications in 13 cancers were compared. Considerable inconsistencies in the direction of whether to support the use of FDG PET/CT were observed in 10 (20.1%) indications pertaining to 8 cancer types: head and neck cancer (treatment response assessment), colorectal cancer (staging in patients with stages I-III disease), esophageal cancer (staging), breast cancer (restaging and treatment response assessment), cervical cancer (staging in patients with stage < IB2 disease and treatment response assessment), ovarian cancer (restaging), pancreatic cancer (diagnosis), and sarcoma (treatment response assessment). CONCLUSIONS: Current guidelines for PET imaging vary in methodological quality and provided considerably inconsistent recommendations. Efforts are needed to improve adherence to guideline development methodologies, to synthesis high-quality evidence, and to adopt standard terminologies. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD42020184965. CLINICAL RELEVANCE STATEMENT: Guidelines for PET imaging provide considerably inconsistent recommendations and vary in methodological quality. It is suggested that clinicians be critical of these recommendations when applying them in practice, that guideline developers adopt more rigorous development methodologies, and that researchers prioritize research gaps identified by current guidelines. KEY POINTS: * PET guidelines vary in methodological quality and provided inconsistent recommendations. Efforts are needed to improve methodologies, synthesize high-quality evidence, and standardize terminologies. * Among six domains of methodological quality assessed by the AGREE II tool, guidelines for PET imaging performed well in scope and purpose (median 80.6%, inter-quartile range 77.8-83.3%) and clarity of presentation (75%, 69.4-83.3%), but poorly in applicability (27.1%, 22.9-37.5%). * Among the 48 recommendations (for 13 cancer types) compared, conflicts in the direction of whether to support FDG PET/CT use were observed in 10 (20.1%), for 8 cancer types (i.e., head and neck, colorectal, esophageal, breast, cervical, ovarian, pancreatic, and sarcoma). CI - (c) 2023. The Author(s), under exclusive licence to European Society of Radiology. FAU - Li, Qianrui AU - Li Q AUID- ORCID: 0000-0003-0780-8531 AD - Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. FAU - Hou, Wenxiu AU - Hou W AD - Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Wu, Mei AU - Wu M AD - Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. FAU - Li, Ling AU - Li L AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. FAU - Su, Minggang AU - Su M AD - Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Ma, Bin AU - Ma B AD - Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. FAU - Cui, Futao AU - Cui F AD - Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Ren, Yan AU - Ren Y AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. FAU - Xu, Jiayue AU - Xu J AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. FAU - Zou, Kang AU - Zou K AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. FAU - Tian, Rong AU - Tian R AD - Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. rongtiannuclear@126.com. FAU - Sun, Xin AU - Sun X AD - Chinese Evidence-Based Medicine Center, Cochrane China Center, and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. sunxin@wchscu.cn. AD - National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. sunxin@wchscu.cn. AD - Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. sunxin@wchscu.cn. LA - eng GR - 7210040335/National Natural Science Foundation of China/ GR - 81971653/National Natural Science Foundation of China/ GR - ZYYC08003/West China Hospital, Sichuan University/ GR - ZYJC21063/West China Hospital, Sichuan University/ PT - Journal Article DEP - 20230614 PL - Germany TA - Eur Radiol JT - European radiology JID - 9114774 RN - 0Z5B2CJX4D (Fluorodeoxyglucose F18) SB - IM MH - Female MH - Humans MH - Positron Emission Tomography Computed Tomography/methods MH - Fluorodeoxyglucose F18 MH - Positron-Emission Tomography MH - *Sarcoma MH - *Soft Tissue Neoplasms OTO - NOTNLM OT - AGREE II OT - Clinical practice guideline OT - Positron emission tomography/computed tomography EDAT- 2023/06/14 13:07 MHDA- 2023/10/27 06:42 CRDT- 2023/06/14 11:05 PHST- 2022/12/22 00:00 [received] PHST- 2023/05/15 00:00 [accepted] PHST- 2023/05/03 00:00 [revised] PHST- 2023/10/27 06:42 [medline] PHST- 2023/06/14 13:07 [pubmed] PHST- 2023/06/14 11:05 [entrez] AID - 10.1007/s00330-023-09786-8 [pii] AID - 10.1007/s00330-023-09786-8 [doi] PST - ppublish SO - Eur Radiol. 2023 Nov;33(11):7879-7889. doi: 10.1007/s00330-023-09786-8. Epub 2023 Jun 14.