Routine PET Surveillance for Endometrial Carcinoma in Remission
Routine PET scanning should not be scheduled for surveillance in this patient with endometrial carcinoma in complete remission, as there is no evidence supporting routine surveillance imaging in asymptomatic cancer patients, and such imaging increases false-positive results, unnecessary procedures, and costs without improving survival or quality of life.
Evidence Against Routine PET Surveillance
The strongest evidence comes from multiple high-quality guidelines explicitly recommending against routine PET surveillance across various cancer types:
- Lymphoma guidelines from the European Society for Medical Oncology state that PET surveillance is explicitly discouraged and should not be performed routinely because it is ineffective and costly 1
- Breast cancer guidelines from the American Society of Clinical Oncology recommend against FDG-PET scanning for routine surveillance, as there is no evidence of impact on survival, quality of life, or cost-effectiveness despite potentially higher sensitivity 2
- Colon cancer guidelines from NCCN state that PET scan is not routinely recommended for surveillance 2
- Hodgkin lymphoma guidelines explicitly state that PET should not be used for routine surveillance following completion of therapy 2
Why Routine PET Surveillance Causes Harm
The evidence demonstrates several critical problems with routine PET surveillance:
- High false-positive rates: PET surveillance has an 11% false-positive rate even in breast cancer populations, leading to unnecessary biopsies, additional imaging, and patient anxiety 2
- No survival benefit: A systematic review of PET surveillance in lymphoma, colorectal cancer, and head and neck cancer found insufficient evidence to support clinical benefit, with only one small randomized trial (65 patients) suggesting potential benefit 3
- Detection without benefit: While PET may detect recurrences earlier than clinical examination, the majority of clinically significant relapses are detected by patient-reported symptoms between scheduled visits 1
Appropriate Surveillance Strategy for Endometrial Carcinoma
Based on general oncology surveillance principles and the patient's specific situation (nearly 2 years in complete remission with normal PET at 1 year 9 months):
- Clinical follow-up: History and physical examination every 3-6 months for the first 2-5 years, then annually, focusing on symptoms of recurrence 1
- Symptom-directed imaging only: Reserve PET or CT imaging for evaluation of specific clinical concerns, new symptoms, or equivocal physical examination findings 2, 1
- No routine imaging: Routine surveillance CT or PET scans should not be ordered in asymptomatic patients 1
When to Consider PET Imaging
PET should only be performed in this patient if:
- New symptoms develop suggesting possible recurrence (vaginal bleeding, pelvic pain, unexplained weight loss) 4
- Physical examination reveals suspicious findings requiring further evaluation
- Tumor markers become elevated (if being monitored) and require anatomic localization
- At least 6 weeks have passed since any surgical intervention to avoid false-positives from post-operative inflammation 5, 6
Critical Pitfalls to Avoid
- Do not order routine surveillance imaging in asymptomatic patients, as it provides no survival benefit and creates potential for false positives leading to unnecessary interventions 1, 3
- Do not ignore patient-reported symptoms between scheduled visits, as these detect the majority of clinically significant relapses 1
- Do not perform PET too soon after surgery (wait at least 6 weeks) to avoid false-positives from physiological post-operative inflammation 5, 6
- Do not rely on imaging alone for treatment decisions; biopsy confirmation is mandatory before initiating salvage therapy 1