Personalised PET imaging in oncology: an umbrella review of meta-analyses to guide the appropriate radiopharmaceutical choice and indication

Margarita Kirienko; Fabrizia Gelardi; Francesco Fiz; Matteo Bauckneht; Gaia Ninatti; Cristiano Pini; Alberto Briganti; Massimo Falconi; Wim J G Oyen; Winette T A van der Graaf; Martina Sollini

doi:10.1007/s00259-024-06882-9

Personalised PET imaging in oncology: an umbrella review of meta-analyses to guide the appropriate radiopharmaceutical choice and indication

Eur J Nucl Med Mol Imaging. 2024 Sep 11. doi: 10.1007/s00259-024-06882-9. Online ahead of print.

Authors

Margarita Kirienko^#¹, Fabrizia Gelardi^#², Francesco Fiz^{3

4}, Matteo Bauckneht^{5

6}, Gaia Ninatti^{7

8}, Cristiano Pini^{9

10}, Alberto Briganti^{2

11}, Massimo Falconi^{2

12}, Wim J G Oyen^{13

14

15}, Winette T A van der Graaf^{16

17}, Martina Sollini^{2

9}

Affiliations

¹ Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
² Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy.
³ Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy.
⁴ Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany.
⁵ Department of Health Science (DISSAL), University of Genoa, Genoa, Italy.
⁶ Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁷ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. g.ninatti@campus.unimib.it.
⁸ Department of Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, 20132, Italy. g.ninatti@campus.unimib.it.
⁹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹⁰ Department of Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, 20132, Italy.
¹¹ Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
¹² Pancreatic and Transplant Surgery Unit, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
¹³ Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
¹⁴ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹⁵ Department of Nuclear Medicine, Humanitas Clinical and Research Center, Milan, Italy.
¹⁶ Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
¹⁷ Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.

^# Contributed equally.

PMID: 39256216
DOI: 10.1007/s00259-024-06882-9

Abstract

Purpose: For several years, oncological positron emission tomography (PET) has developed beyond 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG). This umbrella review of meta-analyses aims to provide up-to-date, comprehensive, high-level evidence to support appropriate referral for a specific radiopharmaceutical PET/computed tomography (CT) or PET/magnetic resonance (MR) in the diagnosis and staging of solid cancers other than brain malignancies.

Methods: We performed a systematic literature search on the PubMed/MEDLINE and EMBASE databases for meta-analyses assessing the accuracy of PET/CT and/or PET/MRI with [¹⁸F]FDG, somatostatin- receptor-targeting ⁶⁸Ga-DOTA-peptides, ¹⁸F-labelled dihydroxyphenylalanine ([¹⁸F]DOPA), prostate-specific membrane antigen (PSMA)-targeted radioligands, and fibroblast activation protein inhibitors (FAPI) in the diagnosis/disease characterisation and staging of solid cancers other than brain tumours.

Results: The literature search yielded 449 scientific articles. After screening titles and abstracts and applying inclusion and exclusion criteria, we selected 173 meta-analyses to assess the strength of evidence. One article was selected from references. Sixty-four meta-analyses were finally considered. The current evidence corroborates the role of [¹⁸F]FDG as the main player in molecular imaging; PSMA tracers are useful in staging and re-staging prostate cancer; somatostatin-targeting peptides (e.g. [⁶⁸Ga]Ga- DOTA-TOC and -TATE) or [¹⁸F]DOPA are valuable in neuroendocrine tumours (NETs). FAPI has emerged in gastric cancer assessment. According to search and selection criteria, no satisfactory meta-analysis was selected for the diagnosis/detection of oesophageal cancer, the diagnosis/detection and N staging of small cell lung cancer and hepatic cell carcinoma, the diagnosis/detection and M staging of melanoma and Merkel cell carcinoma, cervical, vulvar and penis cancers, the N and M staging of lung and gastroenteropancreatic NET, testicular cancer, and chondrosarcoma, and the M staging of differentiated thyroid, bladder and anal cancers.

Conclusion: The comprehensive high-level evidence synthesised in the present umbrella review serves as a guiding compass for clinicians and imagers, aiding them in navigating the increasingly intricate seascape of PET examinations.

Keywords: Oncologic imaging; PET/CT; PET/MR; Positron emission tomography.

Publication types

Review