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

Sep 21, 2026

This umbrella review synthesises up-to-date, high-level evidence from selected meta-analyses to support appropriate referral for personalised positron emission tomography (PET)/CT or PET/MR radiopharmaceutical choices in diagnosing and staging solid cancers other than brain malignancies. It reports results across multiple tracers, including [18F]FDG, 68Ga-DOTA-peptide somatostatin-receptor targeting agents, [18F]DOPA, PSMA-targeted radioligands, and FAPI inhibitors. The evidence supports [18F]FDG as a central molecular imaging tracer, highlights roles for PSMA in prostate cancer staging, neuroendocrine tumour utility for somatostatin-targeting and [18F]DOPA, and emerging FAPI relevance in gastric cancer, while identifying gaps for several tumour types where no satisfactory meta-analysis was selected.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Rationale and development of radiopharmaceuticals

Materials and methods

PRISMA and PROSPERO registration

Search strategy, eligibility criteria, and study selection

European Journal of Nuclear Medicine and Molecular Imaging (2024) 52:208–224 [https://doi.org/10.1007/s00259-024-06882-9](https://doi.org/10.1007/s00259-024-06882-9) REVIEW ARTICLE Personalised PET imaging in oncology: an umbrella review of metaanalyses to guide the appropriate radiopharmaceutical choice and indication Margarita Kirienko1 · Fabrizia Gelardi2 · Francesco Fiz3,4 · Matteo Bauckneht5,6 · Gaia Ninatti7,8 · Cristiano Pini7,8 · Alberto Briganti2,9 · Massimo Falconi2,10 · Wim J. G. Oyen11,12,13 · WinetteT. A. van der Graaf14,15 · Martina Sollini2,7 Received: 30 May 2024 / Accepted: 9 August 2024 / Published online: 11 September 2024 © The Author(s) 2024, corrected publication 2024 Abstract Purpose For several years, oncological positron emission tomography (PET) has developed beyond 2-deoxy-2-[ 18F]fluoroD-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; PSMAtracers 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 Positron emission tomography · PET/CT · PET/MR · Oncologic imaging Margarita Kirienko and Fabrizia Gelardi contributed equally to this work. Extended author information available on the last page of the article Introduction The development of guideline recommendations aims to improve and harmonise patient management. Consensus recommendations are generated through a synthesis of published evidence and clinical experience. Multidisciplinary experts participate and vote on recommendation statements. However, expert panels contributing to cancer-focused guidelines rarely include nuclear medicine specialists [1–6] . Progress in molecular biology, biochemistry, and genetics paved the way for developing increasingly specific radiopharmaceuticals targeting different metabolic pathways, receptors, and cell membrane proteins. While 2-deoxy-2-[ 18F]fluoro-D-glucose ([ 18F]FDG) is still the most used Positron Emission To

FAQs

What is the purpose of this umbrella review in personalised oncology PET imaging?

It aims to provide comprehensive, up-to-date high-level evidence to guide appropriate referral for specific radiopharmaceutical PET/CT or PET/MR in diagnosing and staging solid cancers other than brain tumours.

Which radiopharmaceutical tracers are covered in the meta-analyses assessed?

The review covers [18F]FDG, 68Ga-DOTA-peptides targeting somatostatin receptors, [18F]DOPA, PSMA-targeted radioligands, and fibroblast activation protein inhibitors (FAPI) for diagnosis/characterisation and staging.

What overall evidence conclusions are reported for key tracer roles?

The evidence corroborates [18F]FDG as a main molecular imaging tracer, indicates PSMA tracers are useful for prostate cancer staging and re-staging, shows somatostatin-targeting peptides or [18F]DOPA for neuroendocrine tumours, and notes FAPI has emerged in gastric cancer assessment.

Sep 21, 2026

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