While PET can be useful for evaluation for diagnosis of plasmacytoma and initially that was the only indication lsited by NCCN guidelines, its role for non-secretory myeloma is more controversial. However, NCCN now includes it, which makes it not experimental. In a recent exchange of letters, a correspondent made the claim that such use of PET should have been listed in a review article in the New Engalnd Journal of Medicine. However, the authors resonded: ” We agree that in the setting of nonsecretory myeloma, PET scanning and measurement of free light chains can be helpful in establishing the extent of disease, particularly if protocol participation or intensive therapy is planned. However, the routine use of these tests is not supported by the clinical practice guidelines of the National Comprehensive Cancer Centers Network.” This exchange can be found at http://content.nejm.org/cgi/content/full/352/15/1610
A 2005 guidelines states: “MR and positron emission tomography (PET) scanning may aid disease evaluation in individual patients (grade C recommendation; level III evidence).” This level of evidence falls short of what insurers generally require. However, in its 2010 guidelines, PET/CT is now listed by NCCN.
Durie BG, Waxman AD, D’Agnolo A, Williams CM. Whole-body (18)F-FDG PET identifies high-risk myeloma. J Nucl Med 2002;43:1457-1463.
Smith A, Wisloff F, Samson D, UK Myeloma Forum, Nordic Myeloma Study Group, British Committee for Standards in Haematology. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol 2006 Feb;132(4):410-51. [292 references)