title: FDG PET/CT in cancer: comparison of actual use with literature-based recommendations.
abstract: OBJECTIVE
  The Region of Southern Denmark (RSD), covering 1.2 of Denmark's 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results.
  
  
  METHODS
  A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated "established" and "useful" and grades C and D "potentially useful" and "non-recommendable" indications, respectively.
  
  
  RESULTS
  Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers.
  
  
  CONCLUSIONS
  Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations.
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petersen
authors.affiliation: Department of Nuclear Medicine, Vejle Hospital, Vejle, Denmark.
authors.forename: Paw Christian
authors.initials: PC
authors.lastname: Holdgaard
authors.affiliation: Department of Medicine, Vejle Hospital, Vejle, Denmark.
authors.forename: Poul Henning
authors.initials: PH
authors.lastname: Madsen
authors.affiliation: Department of Haematological, Odense University Hospital, Odense, Denmark.
authors.forename: Lene Meldgaard
authors.initials: LM
authors.lastname: Knudsen
authors.affiliation: Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Gad
authors.affiliation: Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Anders Eggert
authors.initials: AE
authors.lastname: Gravergaard
authors.affiliation: Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Max
authors.initials: M
authors.lastname: Rohde
authors.affiliation: Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Næstved Sygehus, Næstved, Denmark.
authors.forename: Bodil Elisabeth
authors.initials: BE
authors.lastname: Engelmann
authors.affiliation: Organ Centre, Aabenraa Sygehus, Aabenraa, Denmark.
authors.forename: Karsten
authors.initials: K
authors.lastname: Bech
authors.affiliation: Department of Gynaecoligcal and Obstetrics, Aabenraa Sygehus, Aabenraa, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Teilmann-Jørgensen
authors.affiliation: Department of Gynaecoligcal and Obstetrics, Odense University Hospital, Odense, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Mogensen
authors.affiliation: Department of Radiology, Odense University Hospital, Odense, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Karstoft
authors.affiliation: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Johansen
authors.affiliation: Department of Quality and Research/HTA, Odense University Hospital, Odense, Denmark.
authors.forename: Janne Buck
authors.initials: JB
authors.lastname: Christensen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. pfhc@rsyd.dk.
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D003718:Denmark; D019788:Fluorodeoxyglucose F18; D006801:Humans; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Colorectal cancer; Gynaecological cancer; Head and neck cancer; Lung cancer; Malignant lymphoma; Malignant melanoma; PET imaging; Rapid Evidence Assessment; Recommendation