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Update PET/PET-CT evidence for need-based planning in Austria
In July 2020, the Austrian Institute for Health Technology Assessment (AIHTA) issued an updated report on the PET/PET-CT evidence for need-based planning in Austria.
The report is an update of the two already published reports (2015 and 2018) of the Austrian Institute for Health Technology Assessment (AIHTA, formerly known as Ludwig Boltzmann Institute for HTA, LBI-HTA).
The present update aimed to identify oncological indications for which the use of PET/PET-CT is recommended or explicitly not recommended by relevant societies and in evidence-based guidelines. The specific area of application (primary diagnosis, tumor grading, tumor staging/interim staging/re-staging, recurrence staging, and recurrence) for the respective oncological indication was additionally determined.
A comprehensive hand search in guideline databases, websites, and databases of national and supranational societies was performed. The search period was between 20.05.2020 and 19.06.2020. Also, a search for explicitly "inappropriate" recommendations against the application of PET/PET-CT was conducted. Generally, the selection of databases and websites was based on the LBI-HTA Report 2015 and the update from 2018. A total of 37 evidence-based guidelines were used.
The 2020 update resulted in a total of nine changes regarding the overall recommendations and one new cancer indication:
- Esophageal carcinomas (limited, previously controversial)
- Colorectal cancer (controversial, previously limited)
- Ovarian cancer (limited, previously none)
- Prostate cancer (controversial, previously none)
- Testicular carcinoma (controversial, previously none)
- Lymphomas (recommended, previously restricted)
- Neuroendocrine carcinomas (recommended, previously controversial)
- Pancreatic cancer (recommended, previously controversial)
- Renal cancer (controversial, none before)
- Endometrial cancer (new).
The overall recommendations of this update (as in previous years reports 2015 & 2018) rarely show any benefit from PET as a primary or standard diagnosis. This means that PET is usually part of a diagnostic chain or a treatment path based on previous undecided results, and should, therefore, only be used under specific obligations to prevent patient overtreatment/overuse. In general, the present summarized evidence of guidelines can support appropriate health care service provision in Austrian hospitals.
The full report in German can be found here.
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