Accuracy of whole-body FDG-PET and FDG-PET/CT in M staging of nasopharyngeal carcinoma: A systematic review and meta-analysis

Background

A meta-analysis was conducted to evaluate the accuracy of whole-body positron emission tomography (PET) or PET/CT in M staging of nasopharyngeal carcinoma (NPC).

Methods

Through a search of relevant English language studies from October 1996 to September 2011, pooled estimated sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and summary receiver operating characteristic (SROC) curves of whole-body PET or PET/CT in M staging of NPC were calculated.

Results

Three PET and 5 PET/CT studies were identified. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FDG-PET or PET/CT were 0.83 (95% confidence interval [CI], 0.77–0.88), 0.97 (95% CI, 0.95–0.98), 23.38 (95% CI, 16.22–33.69), and 0.19 (95% CI, 0.13–0.25), respectively. The area under curve was 0.9764 and Q* index estimate was 0.9307 for FDG-PET or PET/CT.

Conclusion

Current evidence confirms the good diagnostic performance of the whole-body FDG-PET or PET/CT in M staging of NPC.     

Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer

The purpose is to evaluate the accuracy of integrated ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography ((CT) with intravenous contrast medium in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer, with surgical and histopathological findings used as the reference standard. Forty-five patients with endometrial or uterine cervical cancer underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after PET/CT. PET/CT findings were interpreted by two experienced radiologists in consensus. The criterion for malignancy on PET/CT images was increased tracer uptake by the lymph node, independent of node size. The overall node-based sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting nodal metastases were 51.1% (23/45), 99.8% (1,927/1,931), 85.2% (23/27), 98.9% (1,927/1,949) and 98.7% (1,950/1,976), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in short-axis diameter was 12.5% (2/16), that for between 5 and 9 mm was 66.7% (16/24), and that for 10 mm or larger was 100.0% (5/5). The overall patient-based sensitivity, specificity, positive predictive value ((PPV), negative predictive value (NPV), and accuracy were 50% (6/12), 90.9% (30/33), 66.7% (6/9), 83.3% (30/36) and 80.0% (36/45), respectively. Integrated FDG-PET/contrast-enhanced CT is superior to conventional imaging, but only moderately sensitive in predicting lymph node metastasis preoperatively in patients with uterine cancer.     

18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的系统评价

目的 系统评价18F-FDOPA与18F-FDG PET/CT显像在脑肿瘤诊断中的临床价值.方法 采用Meta分析与直接比较方法.使用计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library,从建库至2016年10月,搜索直接比较18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的诊断性试验.用Meta-Disc 1.4软件进行分析,计算两种不同显像剂的合并敏感度(sensitivity,SEN)、合并特异度(specificity,SPE)、合并阳性似然比(positive likelihood ratio,+LR)、合并阴性似然比(negative likelihood ratio,-LR)、诊断优势比(diagnostic odds ratio,DOR),并绘制综合受试者工作特征曲线计算曲线下面积(area under curve,AUC)与Q*值.结果 最终共纳入4篇文章,Meta 分析结果显示,18F-FDOPA PET/CT对脑肿瘤诊断的合并SEN为0.97(95％ CI =0.90 ～ 1.00),SPE为0.67(95％ CI =0.45 ～0.84),+LR为2.31 (95％ CI=1.40 ～3.81),-LR为0.07 (95％ CI =0.02～ 0.24),DOR为39.72(95％ CI=8.94～176.48),AUC为0.9725,Q*为0.9239.18F-FDG PET/CT对脑肿瘤诊断的合并SEN为0.51(95％CI=0.39～0.63),SPE为0.75(95％ CI=0.53 ～0.90,+LR为l.59(95％ CI=0.70 ～ 3.61),-LR为0.63(95％ CI =0.47 ～0.86),DOR为2.55(95％ CI =0.82 ～7.92),AUC为0.5848,Q*为0.5638.结论 18F-FDOPA PET/CT显像诊断脑肿瘤的敏感性比18F-FDG高,对脑肿瘤具有良好的诊断价值,可作为脑肿瘤诊断的方法之一.     

Clinical value of FDG PET or PET/CT in urinary bladder cancer: a systemic review and meta-analysis

Aim

The purpose of the current study was to conduct a systemic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of FDG PET or PET/CT in urinary bladder cancer.

Materials and methods

The authors conducted a systematic MEDLINE search of articles published between January 2000 and December 2010. Two reviewers independently assessed the methodological quality of each study. We conducted a meta-analysis of pooled sensitivity and specificity in detecting primary and metastatic lesions of bladder cancer.

Results

Six studies met the inclusion criteria. The pooled sensitivity and specificity of PET/CT for primary lesion detection of bladder cancer were 0.90 (95% CI: 0.70–0.99) and 1.00 (95% CI: 0.74–1.00), respectively. The pooled sensitivity and specificity of FDG PET or PET/CT for staging or restaging (metastatic lesions) of bladder cancer were 0.82 (95% CI: 0.72–0.89) and 0.89 (95% CI: 0.81–0.95), respectively.

Conclusion

The diagnostic accuracy of FDG PET or PET/CT is good in metastatic lesions of urinary bladder cancer. Due to the small number of patients and limited number of studies analyzed, the diagnostic capability of FDG PET or PET/CT in detection of primary bladder wall lesions could not be assessed.     

Diagnostic test accuracies of F-18 FDG PET/CT for prediction of microvascular invasion of hepatocellular carcinoma: A meta-analysis

PurposeThe aim of the current meta-analysis was to evaluate diagnostic accuracies of preoperative F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) for prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients.MethodsThe scientific database such as PubMed, Cochrane, and Embase database were searched for studies evaluating diagnostic accuracies of preoperative F-18 FDG PET or PET/CT for prediction of MVI in HCC patients up to November 30, 2020.ResultsFourteen eligible studies (1276 patients) were enrolled. The pooled sensitivity for F-18 FDG PET or PET/CT was 0.67 (95% CI; 0.57–0.76) with heterogeneity and a pooled specificity of 0.80 (95% CI; 0.74–0.85) with heterogeneity. Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.3 (95% CI; 2.5–4.5) and negative likelihood ratio (LR−) of 0.41 (95% CI; 0.31–0.55). The pooled diagnostic odds ratio (DOR) was 8 (95% CI; 5–14). Summary receiver operating characteristic (ROC) curve indicates that the area under the curve was 0.81 (95% CI; 0.78–0.84).ConclusionThe current meta-analysis showed a low sensitivity and moderate specificity of F-18 FDG PET or PET/CT for the prediction of MVI in HCC patients. F-18 FDG PET or PET/CT might not be useful for the preoperative prediction of MVI in HCC patients and should not be used to exclude MVI. Therefore, cautious application and interpretation should be paid to the F-18 FDG PET or PET/CT for the prediction of MVI in HCC patients preoperatively.     

Meta-analysis: comparison of F-18 Fluorodeoxyglucose-positron emission tomography and bone scintigraphy in the detection of bone metastases in patients with breast cancer

PURPOSE: To evaluate the diagnostic properties of FDG-PET and bone scintigraphy in the detection of osseous metastases in patients with breast cancer. MATERIALS AND METHODS: Studies evaluating the diagnostic accuracy of FDG-PET and bone scintigraphy in the diagnosis of osseous metastasis were systematically searched for in the MEDLINE, CINAHL, and EBM Review databases from January 1995 to November 2006. Two reviewers independently abstracted data including research design, sample size, imaging technique and technical characteristics, reference standard, method of image interpretation, and totals of true positives, false positives, true negatives, and false negatives. Per-patient and per-lesion pooled sensitivity and specificity, and area under summary receiver operating characteristic curves were calculated using Meta-Test software. RESULTS: The pooled patient-based sensitivity for FDG-PET was 81% (95% CI: 70%-89%), specificity was 93% (95% CI: 84%-97%), and the area under the curve (AUC) was 0.08. The pooled sensitivity of bone scan was 78% (95% CI: 67%-86%), specificity was 79% (95% CI: 40%-95%), and the AUC was 0.43. The pooled lesion-based sensitivity for FDG-PET was 69% (95% CI: 28%-93%), specificity was 98% (95% CI: 87%-100%), and the AUC was 0.09. The pooled sensitivity for bone scan was 88% (95% CI: 82%-92%), specificity was 87% (95% CI: 29%-99%), and the AUC was 0.81. CONCLUSIONS: It remains inconclusive whether FDG-PET or bone scintigraphy is superior in detecting osseous metastasis from breast cancer. However, FDG-PET does have a higher specificity and may better serve as a confirmatory test than bone scintigraphy and used to monitor response to therapy.     

CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis

Background and purpose

Ovarian cancer is the commonest tumor in female patients with a propensity for recurrence even after primary chemotherapy in early stage. The accuracy of CA 125, PET alone, PET-CT, CT and MRI in diagnosing the recurrent ovarian carcinoma has never been systematically assessed, and present systematic review was aimed at this issue.

Methods

We searched for articles published from January 1995 to November 2007, inclusion criteria including: articles were reported in English or Chinese; CA 125, PET whether interpreted with or without the use of CT, CT or MRI was used to detect recurrent ovarian carcinoma; Histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity.

Result

In 34 included studies, CA 125 had the highest pooled specificity, 0.93 (95% CI: 0.89-0.95); PET-CT had highest pooled sensitivity, 0.91 (95% CI: 0.88-0.94). The AUC of CA 125, PET alone, PET-CT, CT and MRI were 0.9219, 0.9297, 0.9555, 0.8845 and 0.7955, respectively. Results of pairwise comparison between each modality demonstrated AUC of PET, whether interpreted with or without the use of CT, was higher than that of CT or MR, p < 0.05. The pooled sensitivity, pooled specificity and AUC showed no statistical significance between PET alone and PET-CT. There was heterogeneity among studies and evidence of publication bias.

Conclusion

PET-CT might be a useful supplement to current surveillance techniques, particularly for those patients with an increasing CA 125 level and negative CT or MR imaging. However, regarding to diagnostic accuracy, interpreted CT images may have limited additional value on PET in detecting recurrent ovarian cancer.     

18F-FDG PET in the management of endometrial cancer

Purpose Few studies have investigated the clinical impact of whole-body positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (FDG) in endometrial cancer. We aimed to assess the value of integrating FDG-PET into the management of endometrial cancer in comparison with conventional imaging alone.Methods All patients with histologically confirmed primary advanced (stage III/IV) or suspicious/documented recurrent endometrial cancer, with poor prognostic features (serum CA-125 >35 U/ml or unfavourable cell types), or surveillance after salvage therapy were eligible. Before FDG-PET scanning, each patient had received magnetic resonance imaging and/or computed tomography (MRI-CT). The receiver operating characteristic curve method with calculation of the area under the curve (AUC) was used to compare the diagnostic efficacy. Clinical impacts were determined on a scan basis.Results Forty-nine eligible patients were accrued and 60 studies were performed (27 primary staging, 33 post-therapy surveillance or restaging on relapse). The clinical impact was positive in 29 (48.3%) of the 60 scans. Mean standardised uptake values (SUVs) of true-positive lesions were 13.2 (range 5.7–37.4) for central pelvic lesions and 11.1 (range 1.5–37.4) for metastases. The sensitivity of FDG-PET alone (P<0.0001) or FDG-PET plus MRI-CT (P<0.0001) was significantly higher than that of MRI-CT alone in overall lesion detection. FDG-PET plus MRI-CT was significantly superior to MRI-CT alone in overall lesion detection (AUC 0.949 vs 0.872; P=0.004), detection of pelvic nodal/soft tissue metastases (P=0.048) and detection of extrapelvic metastases (P=0.010), while FDG-PET alone was only marginally superior by AUC (P=0.063).Conclusion Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.These data were presented in part at the Tenth Biennial Meeting of the International Gynecologic Cancer Society, Edinburgh, Scotland, October 3–7, 2004     

18F-FDG PET or PET/CT for detecting extrahepatic metastases or recurrent hepatocellular carcinoma: a systematic review and meta-analysis

Aim

Positron emission tomography (PET) using F18-flurodeoxy-glucose (FDG) has been widely used for reflecting cellular metabolism. However, the feasibility of FDG PET in the diagnosis of hepatocellular carcinoma (HCC) is limited. The aim of the study was to assess the ability of FDG PET (PET/CT) in the detection of extrahepatic metastases or recurrent HCC.

Materials and methods

We conducted MEDLINE, EMBASE and COCHRANE searches (last update, April 2011). Eight eligible articles were identified evaluating F18-FDG PET (PET/CT) in extrahepatic metastases or recurrent HCC. Two authors independently evaluated the methodological quality of each study. We estimated pooled sensitivities, specificities, summary receiver-operating-characteristic (SROC) curves, and summary likelihood ratios.

Results

Eight eligible studies were enrolled in this study. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FDG PET (PET/CT) in the detection of metastatic HCC were 76.6%, 98.0%, 14.68, and 0.28, respectively. The pooled estimates of sensitivity, specificity, LR+ and LR− of FDG PET (PET/CT) in the detection of recurrent HCC were 81.7%, 88.9%, 4.72, and 0.19, respectively.

Conclusion

Based on the results of this systematic review, F-18 FDG PET (PET/CT) was useful in ruling in extrahepatic metastases of HCC and valuable for ruling out the recurrent HCC.     

18F-FDG PET, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: a systematic review and meta-analysis

Background and purpose

Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET), combined ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue.

Methods

MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of ¹⁸F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called “Meta-Disc 1.4” was used for data analysis.

Result

In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias.

Conclusion

PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma.     

Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

Purpose

To investigate the diagnostic value of retrospective fusion of pelvic MRI and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer.

Materials and methods

Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.

Results

Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p = 0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p = 1).

Conclusion

Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer.     

ROC曲线评价18F—FDGPET／CT、99Tcm—MDP骨显像及二者联合对骨转移的检出效能

目的采用ROC曲线比较18F-FDGPET／CT、99TcmMDP骨显像及二者联合对骨转移患者的检出效能。方法296例恶性肿瘤患者在2个月内同时接受了18F-FDGPET／CT和99TcmMDP骨显像,对2种显像结果按5分法（0分：骨转移阴性,1分：可能阴性,2分：不能确定,3分：可能阳性,4分：肯定阳性）分别评分,两者之和为联合评分值。以病理诊断或临床随访为确诊“金标准”,采用。检验比较ROC曲线下面积,以评价骨显像、PET／CT及联合评分法对骨转移患者的检出效能,采用r检验比较不同方法在各自最佳诊断阈值下的灵敏度、特异性、准确性、阳性预测值、阴性预测值。结果296例患者中,确诊骨转移阳性61例（占20．6％）、阴性235例（占79．4％）。骨显像、PET／CT及联合评分诊断骨转移的ROC曲线下面积（95％可信区间）分别为0．919（0．867—0．971）、0．949（0．906～0．991）、0．994（0．988～0．999）,联合评分法的曲线下面积明显大于骨显像（z=2．866,P=0．004）和PET／CT（z=2．027,P=0．043）各自单独评分法,骨显像和PET／CT法曲线下面积差异没有统计学意义（z=0．881,P=0．378）。最佳阈值点下,骨显像和PET／CT单独检出骨转移患者的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为90．2％（55／61）、85．1％（200／235）、86．1％（255／296）、61．1％（55／90）、97．1％（200／206）和88．5％（54／61）、97．0％（228／235）、95．3％（282／296）、88．5％（54／61）、97．0％（228／235）,而联合评分检出的结果分别为98．4％（60／61）、95．7％（225／235）、96．3％（285／296）、85．7％（60／70）、99．6％（225／226）。PET／CT对骨转移患者检出的特异性（X2=19．600,P〈0．001）、准确性（X2=13．755,P〈0．001）、阳性预测值（x2=13．608,P〈0．001）均高于骨显像,灵敏度（r=0,P=1．000）差异无统计学意义;与骨显像、PET／CT单独评分比较,联合评分法检出的特异性（X2=19．862,P〈0．001）、准确性（x2=23．361,P〈0．001）和阳性预测值（x2=11．791,P=0．001）均明显高于骨显像,灵敏度明显高于PET／CT（x2=4．167,P=0．031）。结论18F—FDGPET／CT对骨转移患者的检出效能优于99Tcm—MDP骨显像,二者联合明显提高了对骨转移患者的检出率。     

Performance of FDG-PET/CT in the diagnosis of recurrent endometrial cancer

Objective To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18-F-fluorodeoxyglucose (FDG), compared with PET alone, in the diagnosis of suspected endometrial cancer recurrence. Methods Thirty women who had undergone primary surgery for histopathologically proven endometrial cancer with suspected recurrence because of clinical, cytological, biochemical, and/or radiological findings were enrolled in this study. PET and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each modality. A final diagnosis of recurrence was confirmed by histopathology, other imaging and clinical follow-up for longer than 1 year. The statistical significance of differences between PET and PET/CT was determined by the McNemar test. Results Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 93% (14/15), 93% (14/15), and 93% (28/30), respectively, whereas for PET, the corresponding data were 80% (12/15), 80% (12/15), and 80% (24/30), respectively (P = 0.479, 0.479, and 0.134, respectively). CT from PET/CT resolved the false-positive PET results because of hyper-metabolic activity of benign inflammatory lesions and physiological variants and moreover detected lung metastasis and para-aortic lymph node metastasis that PET missed. However, tiny para-aortic lymph node metastasis could not be detected even with PET/CT. Conclusions Integrated FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with endometrial cancer.     

18F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值：Meta分析

目的 系统评价¹⁸F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值。方法 检索PubMed、EMbase、Cochrane Library、中国知网、万方数据、维普数据库从2010年1月—2020年5月公开发表的关于¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的中英文文献,根据纳入、排除标准筛选并提取数据,采用诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入文献质量,应用Meta-Disc 1.4软件进行分析。采用不一致指数(I2)和Cochran-Q检验进行异质性分析,并计算合并敏感度、特异度、阳性似然比、阴性似然比及相应95%CI,绘制汇总受试者操作特征(SROC)曲线并计算曲线下面积(AUC)。采用阈值效应和亚组分析探讨异质性的来源。亚组分析根据研究类型、原发肿瘤类型、是否合并有增强MRI进行分组分析。结果 共纳入25篇文献,包括1 347例肿瘤病人,¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的合并敏感度、特异度、阳性似然比、阴性似然比、AUC值分别为0.85(95%CI:0.8...     

Integrated PET/CT in the preoperative staging of lung cancer: A prospective comparison of CT,PET and integrated PET/CT

Purpose

The purpose of this study was to evaluate the role of integrated PET/CT in the staging of lung cancer compared with CT alone or PET alone.

Materials and methods

Thirty-three patients underwent integrated PET/CT for the staging of lung cancer. The tumor, node and metastasis (TNM) stages were assessed with CT, PET and integrated PET–CT and compared with the surgical and pathological staging.

Results

CT correctly evaluated the (T) status in (64%) of the patients, PET in (59%) and PET/CT in (86%). CT correctly evaluated the (N) status in (73%) of the patients, PET in (76%), and PET/CT (88%) with accuracy, sensitivity, specificity, PPV and NPV were 73%, 78%, 71%, 50% and 94% for CT, 76%, 67%, 79%, 55% and 95% for PET and 88%, 89%, 88%, 73% and 100% for PET/CT respectively, and for (M) status were 91%, 86%, 92%, 75% and 96% for CT, 88%, 71%, 92%, 71% and 92% for PET and 97%, 100%, 96%, 88% and 100% for PET/CT respectively. Regarding the overall TNM staging CT correctly staged 24 patients. PET correctly staged 23 cases while PET/CT correctly staged 30 cases. A significant difference in the accuracy of overall tumor staging between PET/CT and CT (P = 0.0412) or PET (P = 0.0233).

Conclusion

The integrated PET/CT is superior to either CT or PET in the staging of lung cancer which has an important impact on selection of the appropriate treatment regimen.     

FDG PET/CT for the detection of bone marrow involvement in diffuse large B-cell lymphoma: systematic review and meta-analysis

Purpose

To systematically review and meta-analyse published data on the diagnostic performance of ¹⁸F-FDG PET/CT in detecting bone marrow involvement in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).

Methods

PubMed/MEDLINE and Embase were systematically searched for relevant studies. The methodological quality of each study was assessed. Sensitivities and specificities of FDG PET/CT in individual studies were calculated and meta-analysed with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses-Shapiro-Littenberg method. Weighted summary proportions of discrepancies between the FDG PET/CT and (blind) bone marrow biopsy (BMB) results among all patients were calculated.

Results

Seven studies, with a total of 654 patients with newly diagnosed DLBCL, were included. Overall, the quality of the included studies was moderate. The sensitivity and specificity of FDG PET/CT for detecting bone marrow involvement ranged from 70.8 % to 95.8 % and from 99.0 % to 100 %, with pooled estimates of 88.7 % (95 % confidence interval, CI, 82.5 – 93.3 %) and 99.8 % (95 % CI 98.8 – 100 %), respectively. The area under the sROC curve was 0.9983. The weighted summary proportion of FDG PET/CT-negative patients with positive BMB findings among all patients was 3.1 % (95 % CI 1.8 – 5.0 %) and the weighted summary proportion of FDG PET/CT-positive patients with negative BMB findings among all patients was 12.5 % (95 % CI 8.4 – 17.3 %).

Conclusion

FDG PET/CT is accurate and complementary to BMB for detecting bone marrow involvement in patients with newly diagnosed DLBCL. A negative FDG PET/CT scan cannot rule out the presence of bone marrow involvement, but positive FDG PET/CT findings obviate the need for BMB for the detection of bone marrow involvement in these patients.     

Performance of FDG-PET/CT for diagnosis of recurrent uterine cervical cancer

The purpose is to evaluate the accuracy of integrated FDG-PET/CT, compared with PET alone, for diagnosis of suspected recurrence of uterine cervical cancer. Fifty-two women who had undergone treatment for histopathologically proven cervical cancer received PET/CT with suspected recurrence. PET-alone and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each investigation. A final diagnosis was confirmed by histopathology, radiological imaging, and clinical follow-up for over 1 year. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 92.0% (23/25), 92.6% (25/27), and 92.3% (48/52), respectively, while for PET, the corresponding figures were 80.0% (20/25), 77.8% (21/27), and 78.8% (41/52), respectively. PET/CT resolved the false-positive PET results due to hypermetabolic activity of benign/inflammatory lesions and physiological variants, and was able to detect lung metastasis, local recurrence, peritoneal dissemination, para-aortic lymph node metastasis, and pelvic lymph node metastasis missed by PET alone. However, tiny local recurrence and lymph node metastasis could not be detected even by PET/CT. FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with cervical cancer.     

Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey

Objective The aim of this study is to survey the situation of ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening in Japan and to describe its performance profile. Methods “FDG-PET for cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. We sent questionnaires regarding FDG-PET cancer screening to 99 facilities in which FDG-PET tests were performed during the fiscal year 2005. Replies were obtained from 68 of the 99 facilities, of which 46 facilities performed FDG-PET cancer screening. The total number of subjects who underwent FDG-PET cancer screening was 50 558. From 38 of 46 facilities, reliable results of thorough examinations were obtained for the subjects who were positive by FDG-PET and/or one or more of the combined screening tests was performed and were referred for further evaluation. The total number of subjects in these 38 facilities amounted to 43 996. Results A total of 50 558 healthy subjects underwent FDG-PET (including PET/CT) scanning with or without other tests for cancer screening in 46 PET centers during the fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases as a result of positive findings suggesting possible cancer. On analyzing 43 996 cases from 38 PET centers from which detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% were PET positive and 0.24% were PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of the thyroid, colon/rectum, lung, and breast were most frequently found (107, 102, 79, and 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, and 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had a better detection rate, sensitivity, and positive predictive value than dedicated PET (P < 0.01). Conclusions We were able to clarify the performance profile of “FDG-PET for cancer screening” on the basis of a Japanese nationwide survey. The number of facilities possessing PET is increasing steadily, highlighting the necessity of evaluating the usefulness of “FDG-PET cancer screening” as soon as possible by undertaking long-term investigations of large series of subjects.     

^18F-FDG PET显像用于脑胶质瘤分级的Meta分析

目的用Meta分析法综合评价18F—FDGPET显像对脑胶质瘤分级的能力。方法搜索Medline、中国期刊网关于”F-FDGPET显像诊断脑胶质瘤的中英文文献。提取文献中用半定量法或目测法判定胶质瘤恶性程度的数据,同时按照Cochrane工作组推荐的诊断评价标准进行文献的质量方法学评估。用Meta分析软件（Meta—Disc）对纳入文献汇总分析,获得汇总灵敏度（Se）和特异性（Sp）及其95％可信区间（a）,并绘制汇总受试者工作特征（SROC）曲线,计算曲线下面积（AUC）。结果共获取文献17篇（英文16篇、中文1篇）,其中11篇可获取用半定量法[肿瘤／皮质放射性比值（T／C）组及肿瘤／白质放射性比值（T／W）组]判定胶质瘤恶性程度的数据,共272例患者;9篇可获取以目测法判定胶质瘤恶性程度的数据,共481例患者（目测组,部分文献包含2种以上判定方法）。通过异质性检验,分别采用不同效应模型进行分析。T／C组、T／W组和目测组的汇总Se分别为0．952,0．857和0．810;Sp分别为0．409,0．538和0．870;诊断比值（DOR）分别为11．746,22．066和15．282。汇总Se的95％CI分别为0．903—0．980、0．768～0．922和0．757—0．855;汇总Sp的95％凹分别为0．318～0．504,0．431—0．642和0．819～0．911;汇总DOR的95％口分别为5．368—25．702,7．077～68．800和3．716～62．851。3组AUC分别为0．8604,0．8373和0．8724。结论利用18F-FDGPET显像对脑胶质瘤进行恶性程度预测时,半定量组的Se较高,有利于阳性病例的检出,目测组sp较高,有利于阴性病例的排除。根据AUC判断,目测组总体诊断效能最高,T／C组次之,T／W组再次。     

Meta-analysis of the performance of 18F-FDG PET in cutaneous melanoma

Introduction

The aim of this study was to perform a systematic review of the literature to evaluate the accuracy of FDG-PET in staging and restaging of cutaneous melanoma.

Methods

Systematic methods were used to identify, select, and evaluate the methodologic quality of the studies as well as to summarize the overall findings of sensitivity and specificity. The search strategy consisted of identifying studies published between 2000 and 2006. Inclusion criteria were studies that evaluated the diagnostic performance of FDG-PET in staging/restaging of cutaneous melanoma. The results were compared and pooled with a meta-analysis published previously that included studies published until 1999. The meta-analysis included 95% confidence intervals (CI) of sensitivity, specificity, likelihood-ratio (LR), and diagnostic-odds-ratio (DOR).

Results

The quantitative meta-analysis included 24 studies that were analysed in two groups: eight studies were included only in the regional staging analysis (group I), 13 studies were included only in the detection of distant metastases analysis (group II), and three studies were included in both analyses. Compliance with the methodologic-quality criteria was acceptable. We analysed the results of data presented in patients, lesions, basins, lymph-nodes, areas, and scans. Regarding the performance of FDG-PET in the detection of metastases, the pooled studies presented homogeneity for the negative-LR (0.15; 95% CI, 0.10–0.22) when analyzing lesions. When analyzing scans, there was global homogeneity for specificity (0.86; 95% CI, 0.77–0.92), positive-LR (5.86; 95% CI, 3.64–9.43), and DOR (37.89; 95% CI, 15.80–90.86). The pooled studies presented heterogeneity for the other items analysed. Regarding the detection of regional metastases, when analyzing lymph-nodes there was global homogeneity for specificity (0.99; 95% CI, 0.97–0.99; P?=?0.101). The meta-regression evidenced that the variable that most influenced the DOR of the different studies and that can explain the heterogeneity was the year of publication; this may be related to the evolution of PET technology and an improvement of sensitivity/specificity.

Conclusion

FDG-PET is not useful in the evaluation of regional metastases, as it does not detect microscopic disease. However, FDG-PET could be useful in the detection of distant metastases, and could suggest its utility in the management of patients with cutaneous melanoma.