Abstract
Positron emission tomography (PET) has been a widely used tool in oncology for staging lymphomas for a long time. Recently, several large clinical trials demonstrated its utility in therapy management during treatment, paving the way to personalized medicine. In doing so, the traditional way of reporting PET based on the extent of disease has been complemented by a discrete scale that takes in account tumour metabolism. However, due to several technical, physical and biological limitations in the use of PET uptake as a biomarker, stringent rules have been used in clinical trials to reduce the errors in its evaluation. Within this manuscript we will describe shortly the evolution in PET reporting, examine the main errors in uptake measurement, and analyse which strategy the clinical trials applied to reduce them.
Highlights
Cancer is the second most common cause of death immediately after cardiovascular acute events
The different Positron emission tomography (PET)-derived metrics, standardized uptake value (SUV), metabolic tumour volume (MTV) and total glycolytic volume (TGV) are described in the following sub-chapters with their strengths and limitations
The general prescription is to reach a high level of standardization: this aspect is essential to guarantee an efficient comparison of positron emission tomography computed tomography (PET/CT) metrics acquired at different time points and between different patients, either at a single site or across multiple sites [24,25]
Summary
Cancer is the second most common cause of death immediately after cardiovascular acute events. Several clinical trials demonstrated that treatment could be guided by PET/CT during the treatment itself, changing the ongoing therapy based on its results [6,7] The research in this field is still ongoing and requires a lot of effort, but PET/CT became a true tool for personalized medicine when its results started to be given on a discrete scale [8,9]. Before being implemented in clinical practice, the new assessment tools ought to be proven in the controlled and reproducible environment of clinical trials Both the discrete and the continuous scale depend on PET/CT uptake, which is affected by several confounding factors. The description of the tumour avidity could be done in three different scales: binary, discrete and continuous
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