The DOI matches its Crossref record; 132 of the 157 references it cites were found in a registry or an index.
From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors
Open accessAbstract
UNLABELLED: The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. METHODS: PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. RESULTS: Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. CONCLUSION: Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.
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“SUVmax of normal background tissues, including the liver and mediastinal blood pool are commonly used as references to define the disease and assess tumor response to therapy.[7]”
From Intrapatient variability of 18F-FDG uptake in normal tissues (2022) · cites this paper as [7]
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“However, it has been demonstrated that inter-rater agreement in response assessment with [18F]FDG-PET in non-small cell lung cancer or metastatic breast cancer can be considerably improved through the use of the target lesion SULpeak (PERCIST 1.0 criteria) in comparison with a subjective assessment [194,214,215].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [194]
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Citations
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Cited by
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Items 1,001–1,041 of 1,041
Zhu, H.-C., Hao, S., Tseng, I., Shen, J., del Campo, E. R., Davies, A., Segelov, E., Liu, Q.-F., Chen, Y., Song, S.-L., et al. (2023) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-22-1306
“PET Response Criteria in Solid Tumors (PERCIST) has been used in practice and clinical trials in EC and some other types of solid tumors (82).”
MethodReply: Radiopharmaceutical Extravasations CanHave Consequences
Parihar, A. S., Raymond‐Schmidt, L., Crandall, J. P., Dehdashti, F., & Wahl, R. L. (2023) · Journal of Nuclear Medicine · doi:10.2967/jnumed.123.265920
“activity is important for obtaining reproducible and precise estimates of quantitative parameters such as SUV (2,3).”
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“0 with maintenance of the control of distant metastases documented at diagnosis [2].”
BackgroundLoharkar, S., & Basu, S. (2023) · Indian Journal of Medical and Paediatric Oncology · doi:10.1055/s-0042-1760311
Bildgestützte Beurteilung des Ansprechens auf Immuntherapien bei Hauttumoren
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“The integration of positron emission tomography/magnetic resonance imaging (PET/MRI) systems represents a transformative advancement in medical imaging, combining the metabolic specificity of PET with the superior soft-tissue contrast and multiparametric capabilities of MRI (1).”
InfluentialGarcía, Á. B., de la Torre, J. R. I., Carbonero, R. B., Rodríguez, J. C. C., Esteve, A. M., Vicente, J. S., Granero, P. J., Costero, A. U., & Rayo, J. I. (2023) · Revista Española de Medicina Nuclear e Imagen Molecular · doi:10.1016/j.remn.2022.12.004
Agüloğlu, N., & Aksu, A. (2022) · Revista Española de Medicina Nuclear e Imagen Molecular · doi:10.1016/j.remn.2022.09.003
F-18 FDG PET/CT Imaging in Ovarian Cancer
Topal, E., & Şanlı, Y. (2022) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2022.0020
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“Metabolic response was defined according to PET Response Criteria in Solid Tumors (PERCIST) [22].”
MethodLiu, G., Fontaine, M. L. L., Weisman, A., Houshmandi, S. S., Lokre, O., Jeraj, R., & Perk, T. (2022) · Annals of Oncology · doi:10.1016/j.annonc.2022.07.107
Lokal fortgeschrittenes NSCLC: Immun- und Radiotherapie ohne Chemotherapie?
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Singh, P., Singh, R., Sharma, N., Sharma, M., & Kumar, S. (2022) · Scaffold Press Books · doi:10.52679/978-81-952885-6-4_1
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PERITONEAL CARCINOMATOSIS SECONDARY TO OVARIAN CANCER: IMAGING FINDINGS
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La gestione multidisciplinare delle metastasi ossee nel carcinoma tiroideo
Minaldi, E., Viola, D., Elisei, R., & Agate, L. (2021) · L Endocrinologo · doi:10.1007/s40619-021-00976-4
“Wahl RL, Jacene H, Kasamon Y et al (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors.”
MethodInfluentialBaşoğlu, T., Özgüven, S., Sahin-Ozkan, H., Çınar, M., Kostek, O., Demircan, N. C., Arıkan, R., Telli, T. A., Ercelep, Ö., Kaya, H., et al. (2021) · Revista Española de Medicina Nuclear e Imagen Molecular · doi:10.1016/j.remn.2021.04.003
Method to Determine the Statistical Technical Variability of SUV Parameters
Luca, G. D. D., & Habraken, J. (2021) · doi:10.21203/rs.3.rs-929870/v1
“The proposed framework for PET Response Criteria in Solid Tumours (PERCIST) suggests to consider a 30% change in SUV as signi cant variation of tumour activity [4].”
MethodStolniceanu, C., Moscalu, M., Azoicǎi, D., Tamba, B., Volovăț, C., Grierosu, I., Ionescu, T., Jalloul, W., Ghizdovăț, V., Gherasim, R., et al. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11101042
“Different backgrounds were used in different studies, such as liver, lung, bone, heart, thighs and mediastinum, sometimes related to the tumour localisation [23,33].”
MethodEaton, K., Romine, P., Martins, R., Leblond, A., Carr, L., & Vesselle, H. (2021) · Cureus · doi:10.7759/cureus.18804
“This is based on data demonstrating that response by CT is a surrogate marker for improved predict progression-free (PFS), overall survival (OS), and quality of life (QOL) [1-3].”
Method维莫非尼治疗BRAFV600E突变型Erdheim-Chester病的疗效与安全性分析
Liu, T., He, T., Niu, N., Li, J., Zhou, D.-B., & Cao, X.-X. (2021) · Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi · doi:10.3760/cma.j.issn.0253-2727.2021.09.007
“[10] Wahl RL, Jacene H, Kasamon Y, et al.”
BackgroundWulandari, L., Soegiarto, G., Febriani, A., Fatmawati, F., & Amran, W. S. (2021) · Asian Journal of Oncology · doi:10.1055/s-0041-1730255
Hayes, A., Chan, D., Chan, B., & Pavlakis, N. (2021) · Journal of neuroendocrinology · doi:10.1111/jne.13015
PET/CT Imaging for Evaluation of Treatment Response in Breast Cancer
Nursal, G. N. (2021) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2021.0015
“İlk olarak 2009 yılında tanımlanan PERCIST kriterleri (16) ve daha az oranda EORTC kriterleri (25) tümör yanıtının semikantitatif değerlendirmesi için kullanılmaktadır.”
BackgroundInfluentialFDG PET/CT in Treatment Response Evaluation of Head and Neck Tumors
Akkaş, B. (2021) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2021.0013
“Metabolik veriler ilk olarak Avrupa Kanser Araştırma ve Tedavi Organizasyonu’nun geliştirdiği yanıt kriterleri ile (European Organization for Research and Treatment of Cancer - EORTC) ve sonrasında 2009 yılında Solid Tümörlerde PET Yanıt Kriterleri (PET response Criteria in Solid Tumors - PERCIST) ile değerlendirmeye…”
Ga-68 PSMA PET/CT in the Evaluation of Treatment Response in Prostate Cancer
Toplutas, K. N., Kabasakal, L., & Ekmekçioğlu, Ö. (2021) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2021.0024
The Role of PET/CT in the Evaluation of Tumour Response to Immunotherapy
Yıldız, A., Şahin, Z., & Forouz, A. (2021) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2021.0019
“Sonrasında daha standart yaklaşım getirebilmek amacıyla Solid Tümörlerde PET Yanıt Kriterleri ( PET Response Criteria in Solid Tumors - PERCIST) geliştirilmiştir (21).”
Karaçavuş, S. (2021) · Nuclear Medicine Seminars · doi:10.4274/nts.galenos.2021.0012
Foley, K., Lavery, A., Napier, E., Campbell, D., Eatock, M., Kennedy, R., Bradley, K., & Turkington, R. (2021) · Scientific Reports · doi:10.1038/s41598-021-92545-w
Update of Assessment of Early Response Using PET/CT in Malignant Lymphoma.
Mattar, M., & Moustafa, H. (2021) · doi:10.21608/egyjnm.2021.172721
“The usage of a standardized delineating procedure with window and color settings that are previously defined in advance can aid in reducing the discrepancies in the target delineation (20) .”
BackgroundKim, Y.-I., Kim, J.-S., Kwon, J., Kim, S., Seo, Y., Koo, B., Chang, J.-W., & Cho, M. (2021) · doi:10.21593/kjhno/2021.37.1.17
Goubey, J.-B. L., Lasnon, C., Nakouri, I., Césaire, L., Depontville, M., Nganoa, C., Kottler, D., & Aide, N. (2021) · doi:10.20944/preprints202105.0638.v1
“It is noteworthy that despite stability of tumour 18F-FDG uptake, the target lesion also displayed a significant increase in tumour metabolic, active tumour volume (MATV) and should therefore had been classified as progressive disease if PERCIST criteria [32] had been applied.”
Method
Metadata
- Authors
- Wahl, R. L., Jacene, H., Kasamon, Y., & Lodge, M. A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Wahl, Richard L.
- Venue
- Journal of Nuclear Medicine
- Publisher
- Society of Nuclear Medicine
- Published
- 2009-04-29
- Volume
- 50
- Issue
- Suppl 1
- Pages
- 122S-150S
- ISSN
- 0161-5505 (ISSN-L)
- 2159-662X
- PMC
- PMC2755245
- OpenAlex
- W2155263737
- Cited by
- 3,777
- References
- 157
- Citations by year
- 2026: 180 · 2025: 200 · 2024: 197 · 2023: 230 · 2022: 248 · 2021: 309 · 2020: 271 · 2019: 259 · 2018: 225 · 2017: 274 · 2016: 246 · 2015: 245 · 2014: 221 · 2013: 230 · 2012: 192
- FWCI
- 21.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Nuclear Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (CA006973, P30CA006973)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- RECIST, PERCIST, 18F-FDG PET, tumor response assessment, standardized uptake value, WHO criteria, RECIST 1.1, region of interest, treatment response assessment, solid tumors, lymphoma, sarcoma, hepatocellular carcinoma, mesothelioma, gastrointestinal stromal tumor, test-retest variability
- MeSH terms
- Forecasting, Humans, Neoplasms, Prognosis, World Health Organization, Treatment Outcome, Outcome Assessment, Health Care, Practice Guidelines as Topic, Radiopharmaceuticals, Fluorodeoxyglucose F18, Internationality, Positron-Emission Tomography
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