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European Radiology Oct 2020To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer.
METHODS
Pubmed and Embase databases were searched for studies published from 2000 to 2019 that used ultrasound (US), CT, MRI, and/or PET for evaluating various aspects of local extent and nodal metastasis in patients with newly diagnosed cervical cancer. Sensitivities and specificities from the studies were meta-analytically pooled using bivariate and hierarchical modeling.
RESULTS
Of 1311 studies identified in the search, 115 studies with 13,999 patients were included. MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71-0.88 and 0.86-0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively-performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29-0.69) but high specificity (0.88-0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site).
CONCLUSIONS
MRI is the method of choice for assessing any aspect of local extent, but where not available, US could be of value, particularly for assessing PMI. CT, MRI, and PET all have high specificity but poor sensitivity for the detection of lymph node metastases.
KEY POINTS
• Magnetic resonance imaging is the method of choice for assessing local extent. • Ultrasound may be helpful in determining parametrial invasion, especially in lower-resourced countries. • Computed tomography, magnetic resonance imaging, and positron emission tomography perform similarly for assessing lymph node metastasis, with high specificity but low sensitivity.
Topics: Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Positron-Emission Tomography; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Uterine Cervical Neoplasms
PubMed: 32415584
DOI: 10.1007/s00330-020-06909-3 -
The utility of F-FDG PET and PET/CT in the diagnosis and staging of chondrosarcoma: a meta-analysis.Journal of Orthopaedic Surgery and... Jun 2020Chondrosarcoma is the second most common primary bone sarcoma; however, unlike other tumors, the biopsy cannot easily make a definite diagnosis or predict the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Chondrosarcoma is the second most common primary bone sarcoma; however, unlike other tumors, the biopsy cannot easily make a definite diagnosis or predict the histological grade. This meta-analysis was performed to evaluate the utility of F-FDG PET and PET/CT to differentiate chondrosarcoma from benign cartilaginous lesions and to predict the histopathological grade of chondrosarcoma.
MATERIAL AND METHODS
A comprehensive search was performed in three electronic databases including Medline/PubMed, the Cochrane Library and Embase to retrieve diagnostic studies evaluating the role of F-FDG PET or PET/CT for appraising the status of chondrosarcoma. Reference lists of related articles were also scrutinized manually. Useful data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the summary receiver operating characteristic curve (sROC), and the area under the curve (AUC) of F-FDG PET or PET/CT in diagnosing chondrosarcoma, and pooled weighted mean differences (WMD) of maximum standardized uptake value (SUVmax) between different entities of cartilaginous neoplasms by using Stata 19.0.
RESULTS
A total of twelve studies provided sufficient data for the quantitative analysis. For the diagnosis of chondrosarcoma, the pooled sensitivity, specificity, and DOR of F-FDG PET were 0.84 (95% confidence interval [CI] 0.46 to 0.97), 0.82 (95% CI 0.55 to 0.94), and 24.244 (95% CI 1.985 to 96.148), respectively while those of F-FDG PET/CT were 0.94 (95% CI 0.86 to 0.97), 0.89 (95% CI 0.82 to 0.93), and 112.999 (95% CI 41.341 to 308.866), respectively. The pooled WMD of SUVmax were - 0.89 (95% CI -1.67 to -0.10) between benign cartilaginous lesions and grade 1 (G1) chondrosarcoma, -1.94 (95% CI -2.76 to -1.12) between G1 and grade 2 (G2) chondrosarcoma, and - 2.37 (95% CI -5.79 to 1.05) between G2 and grade 3 (G3) chondrosarcoma.
CONCLUSIONS
In a word, F-FDG PET/CT revealed excellent accuracy in the diagnosis of chondrosarcoma and might assist in clinical decision-making. Meanwhile, although SUVmax alone showed restricted ability to differentiate benign cartilaginous lesions and G1 chondrosarcoma, as well as between G2 and G3 chondrosarcoma, it can identify intermediate/high-grade chondrosarcoma from low-grade ones.
LEVEL OF EVIDENCE
Level I evidence, a summary of meta-analysis.
Topics: Bone Neoplasms; Chondrosarcoma; Fluorodeoxyglucose F18; Humans; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals
PubMed: 32571371
DOI: 10.1186/s13018-020-01748-w -
Hellenic Journal of Nuclear Medicine 2020A meta-analysis was performed to compare the diagnostic performance of gallium-68 (Ga) somatostatin receptor positron emission tomography (Ga-SSTR PET) and... (Meta-Analysis)
Meta-Analysis
Comparison of gallium-68 somatostatin receptor and F-fluorodeoxyglucose positron emission tomography in the diagnosis of neuroendocrine tumours: A systematic review and meta-analysis.
OBJECTIVE
A meta-analysis was performed to compare the diagnostic performance of gallium-68 (Ga) somatostatin receptor positron emission tomography (Ga-SSTR PET) and fluorine-18-fluorodeoxyglucose (F-FDG) PET in patients with neuroendocrine tumours (NET) and whether the two imaging modalities can be mutually substituted in clinical work.
METHODS
We performed electronic literature searches of the MEDLINE, PubMed, Embase and Cochrane Library databases for English-language articles from the earliest available date of indexing through 30 July 2019. We calculated the pooled sensitivity, specificity and diagnostic odds ratios (DOR) with 95% confidence intervals (95% CI) of Ga-SSTR PET and F-FDG PET in NET. We drew a summary receiver operator characteristic (SROC) curve and calculated the area under the curve (AUC) to measure the accuracy of Ga-SSTR PET and F-FDG PET in patients or lesions with NET.
RESULTS
Thirty studies comprising 3401 patients and 5793 lesions with NET were included in this meta-analysis. The pooled sensitivity, sensitivity, DOR and AUC for Ga-SSTR PET or PET/computed tomography (CT) in the diagnosis of NET, based on lesion patient, were 0.92(0.89-0.95), 0.91(0.83-0.95),119(51-282) and 0.96(0.94-0.98), and based on lesion, were 0.95(0.86-0.98), 0.93(0.83-0.97), 229(43-1205) and 0.98(0.96-0.99), respectively. The pooled sensitivity, sensitivity, DOR and AUC for F-FDG PET or PET/CT in NET were 0.70(0.41-0.89), 0.97(0.70-1.00), 67(7-612) and 0.94(0.92-0.96), respectively, when analyzed on a per-patient basis.The pooled sensitivities of Ga-SSTR PET/CT were 0.923 (95% CI: 0.884-0.952), 0.902 (0.862-0.934) and 0.578 (0.482-0.669) in the G1(ki67,≤2%), G2(ki67,>3%,≤20% and G3(ki67,>20%) groups based on patients with NET, respectively. The pooled sensitivities of F-FDG PET/CT were 0.378 (0.319-0.440), 0.554 (0.492-0.615) and 0.712 (0.633-0.783) in the G1, G2 and G3 groups based on patients with NET, respectively.
CONCLUSION
The Ga-SSTR PET has highly sensitive and had a greater diagnostic value than F-FDG PET for patients with NET. Fluorine-18-FDG PET, however, had significant specificity than Ga-SSTR PET. The Ga-SSTR has high sensitivity in G1/G2 NET, while F-FDG has a low positive rate. In G3 NET, however, the opposite is true. Therefore, the Ga-SSTR PET and F-FDG PET modalities are complementary rather than substitutive in clinical practice.
Topics: Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Neuroendocrine Tumors; Positron-Emission Tomography; Receptors, Somatostatin
PubMed: 32716410
DOI: 10.1967/s002449912108 -
Journal of Orthopaedic Surgery and... Aug 2021Bone marrow infiltration (BMI) is a devastating stage of paediatric lymphoma. Prompt diagnosis of BMI in newly diagnosed paediatric lymphoma patients is critical but can... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bone marrow infiltration (BMI) is a devastating stage of paediatric lymphoma. Prompt diagnosis of BMI in newly diagnosed paediatric lymphoma patients is critical but can be very challenging at present.
METHODS
We systematically retrieved studies from PubMed, EMBASE, and the Cochrane Library. Data extraction and quality assessment were performed by two reviewers independently. A total of nine eligible studies were included in the quantitative analysis.
RESULTS
The pooled sensitivity and specificity of FDG-PET/CT for diagnosing BMI in newly diagnosed paediatric lymphoma patients were 0.97 (95% confidence interval [CI], 0.93 to 0.99) and 0.99 (95% CI, 0.98 to 0.99), respectively. The pooled PLR, NLR, and DOR were 79.9 (95% CI, 42.7 to 149.6), 0.03 (95% CI, 0.01 to 0.17), and 2414.6 (95% CI, 989.6 to 5891.4), respectively. The AUC of FDG-PET/CT for BMI was 1.00 (95% CI, 0.99 to 1.00). Compared with FDG-PET/CT, BMB had a lower pooled sensitivity (0.44, 95% CI, 0.34 to 0.55) and comparable pooled specificity (1.00, 95% CI, 0.92 to 1.00).
CONCLUSION
Compared with BMB, FDG-PET/CT was a more valuable diagnostic method for evaluating BMI in paediatric Hodgkin and non-Hodgkin lymphoma patients with extremely high diagnostic accuracy.
Topics: Biopsy; Bone Marrow; Child; Fluorodeoxyglucose F18; Humans; Lymphoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 34372894
DOI: 10.1186/s13018-021-02521-3 -
International Journal of Molecular... Feb 2023Cancer is the leading cause of death around the globe, followed by heart disease and stroke, with the highest mortality to this day. We have reached great levels of... (Review)
Review
Cancer is the leading cause of death around the globe, followed by heart disease and stroke, with the highest mortality to this day. We have reached great levels of understanding of how these various types of cancer operate at a cellular level and this has brought us to what we call "precision medicine" where every diagnostic examination and the therapeutic procedure is tailored to the patient. FAPI is among the new tracers that can be used to assess and treat many types of cancer. The aim of this review was to gather all the known literature on FAPI theranostics. A MEDLINE search was conducted on four web libraries, PUBMED, Cochrane, Scopus, and Web of Sciences. All of the available articles that included both diagnoses and therapy with FAPI tracers were collected and put through the CASP (Critical Appraisal Skills Programme) questionnaire for systematic reviewing. A total of 8 records were deemed suitable for CASP review, ranging from 2018 to November 2022. These studies were put through the CASP diagnostic checklist, in order to assess the goal of the study, diagnostic and reference tests, results, descriptions of the patient sample, and future applications. Sample sizes were heterogeneous, both for size as well as for tumor type. Only one author studied a single type of cancer with FAPI tracers. Progression of disease was the most common outcome, and no relevant collateral effects were noted. Although FAPI theranostics is still in its infancy and lacks solid grounds to be brought into clinical practice, it does not show any collateral effects that prohibit administration to patients, thus far, and has good tolerability profiles.
Topics: Humans; Precision Medicine; Heart Diseases; PubMed; Sample Size; Fibroblasts; Positron Emission Tomography Computed Tomography; Gallium Radioisotopes; Fluorodeoxyglucose F18
PubMed: 36835275
DOI: 10.3390/ijms24043863 -
The British Journal of Radiology Jul 2022The present systematic review and meta-analysis compared the diagnostic performance of F-18 fludeoxyglucose positron emission tomography (F-FDG PET) and conventional... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The present systematic review and meta-analysis compared the diagnostic performance of F-18 fludeoxyglucose positron emission tomography (F-FDG PET) and conventional imaging, including MRI, echocardiography, and CT, in characterising cardiac masses.
METHODS
A literature search of the PubMed, Cochrane, and EMBASE databases for studies comparing the diagnostic accuracies of F-FDG PET and conventional imaging in characterising cardiac masses, from inception of indexing to 31 July 2020, was performed. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. Sensitivity and specificity across the studies were determined, positive and negative likelihood ratios (LR+ and LR-, respectively) were calculated, and summary receiver operating characteristic curves were constructed.
RESULTS
Of six included studies ( = 212 patients), F-FDG PET demonstrated a pooled sensitivity of 0.89 (95% confidence interval [CI] 0.81-0.94) and a pooled specificity of 0.89 (95% CI 0.80-0.94). LR syntheses yielded an overall LR+ of 7.9 (95% CI 4.3-14.6) and LR- of 0.12 (95% CI 0.07-0.22). The calculated pooled diagnostic odds ratio (DOR) was 64 (95% CI 23-181). For conventional imaging, the pooled sensitivity was 0.70 (95% CI 0.57-0.81) and the pooled specificity was 0.96 (95% CI 0.88-0.98). LR syntheses yielded an overall LR+ of 16.1 (95% CI 5.8-44.5) and LR- of 0.31 (95% CI 0.21-0.46). The evaluated pooled DOR was 52 (95% CI 17-155).
CONCLUSION
F-FDG PET and conventional imaging demonstrated comparable diagnostic accuracies for the characterisation of cardiac masses. Further large multicentre studies are, however, required to corroborate the diagnostic performances of F-FDG PET and conventional imaging for the characterisation of cardiac masses.
ADVANCES IN KNOWLEDGE
No previous studies have comprehensively analysed the diagnostic performance of F-FDG PET/CT compared with conventional imaging techniques including echocardiography, CT, and MRI. According to the current study, F-FDG PET/CT yielded a pooled DOR of 64, whereas other conventional imaging techniques demonstrated a DOR of 52. As such, F-FDG PET/CT demonstrated sensitivity and specificity, with a high pooled DOR comparable with other conventional imaging modalities.
Topics: Diagnostic Tests, Routine; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 35612548
DOI: 10.1259/bjr.20210263 -
European Journal of Nuclear Medicine... Nov 2022Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of non-Hodgkin lymphoma as a highly FDG-avid tumor, functional F-FDG PET/CT imaging is already embedded in their routine care. Nevertheless, the question is whether it is still valuable in the context of these tumors being treated with immunotherapy. Herein, we will review the value of F-FDG PET/CT imaging lymphoid tumors treated with immunotherapy regimens.
METHODS
A comprehensive literature search of the PubMed database was conducted on the value of the F-FDG PET/CT for immunotherapy response monitoring of patients with malignant lymphoma. The articles were considered eligible if they met all of the following inclusion criteria: (a) clinical studies on patients with different types of malignant lymphoma, (b) treatment with anti-CD20 antibodies, immune checkpoint inhibitors or immune cell therapies, (c) and incorporated PET/CT with F-FDG as the PET tracer.
RESULTS
From the initial 1488 papers identified, 91 were ultimately included in our study. In anti-CD20 therapy, the highest pooled hazard ratios (HRs) of baseline, early, and late response monitoring parameters for progression-free survival (PFS) belong to metabolic tumor volume (MTV) (3.19 (95%CI: 2.36-4.30)), maximum standardized uptake value (SUVmax) (3.25 (95%CI: 2.08-5.08)), and Deauville score (DS) (3.73 (95%CI: 2.50-5.56)), respectively. These measurements for overall survival (OS) were MTV (4.39 (95%CI: 2.71-7.08)), DS (3.23 (95%CI: 1.87-5.58)), and DS (3.64 (95%CI: 1.40-9.43)), respectively. Early and late F-FDG PET/CT response assessment in immune checkpoint inhibitors (ICI) and immune cell therapy might be an effective tool for prediction of clinical outcome.
CONCLUSION
For anti-CD20 therapy of lymphoma, the MTV as a baseline F-FDG PET/CT-derived parameter has the highest HRs for PFS and OS. The DS as visual criteria in early and late response assessment has higher HRs for PFS and OS compared to the international harmonization project (IHP) visual criteria in anti-CD20 therapy. Early changes in F-FDG PET parameters may be predictive of response to ICIs and cell therapy in lymphoma patients.
Topics: Humans; Antigens, CD20; Fluorodeoxyglucose F18; Immune Checkpoint Inhibitors; Immunotherapy; Lymphoma; Positron Emission Tomography Computed Tomography; Prognosis; Retrospective Studies
PubMed: 35932329
DOI: 10.1007/s00259-022-05918-2 -
European Journal of Medical Research May 2023To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC).
METHODS
This study was conducted and reported in accordance with the PRISMA-DTA statement. Electronic databases (PubMed, Embase, Cochrane Library) were searched for studies on 18F-FDG PET/MRI for diagnosing LN metastasis. The pooled sensitivity (SEN), specificity (SPE), and area under the curve (AUC) were applied to assess the diagnostic performance. Heterogeneity was identified and processed using meta-regression and sensitivity analysis. All data analyses were performed via STATA 15 and Meta-Disc 1.4 software.
RESULTS
There were finally 7 studies included, involving a total of 184 patients. The Spearman rank correlation coefficient was 0.108 (P = 0.818), with no threshold-effect observed. The pooled SEN was 0.81 (95%CI 0.66-0.90) and the SPE was 0.89 (95% CI 0.73-0.96). In sub-groups, prospective groups demonstrated to have the highest SEN of 0.92 (95%CI 0.79-1.00). The studies conducted by Catalano et al. and Kang et al. were considered to be potential sources of heterogeneity.
CONCLUSION
18F-FDG PET/MRI has shown remarkable diagnostic performance in identification of LN metastases in newly diagnosed CRC patients. It would be of great application value for the primary staging of CRC lymph node metastases.
Topics: Humans; Fluorodeoxyglucose F18; Radiopharmaceuticals; Sensitivity and Specificity; Positron-Emission Tomography; Magnetic Resonance Imaging; Lymph Nodes; Colorectal Neoplasms; Neoplasm Staging
PubMed: 37143144
DOI: 10.1186/s40001-023-01124-4 -
BMC Infectious Diseases Mar 2022[18F]FDG-PET/CT is used for diagnosing metastatic infections in Staphylococcus aureus bacteremia (SAB) and guidance of antibiotic treatment. The impact of...
OBJECTIVES
[18F]FDG-PET/CT is used for diagnosing metastatic infections in Staphylococcus aureus bacteremia (SAB) and guidance of antibiotic treatment. The impact of [18F]FDG-PET/CT on outcomes remains to be determined. The aim of this systematic review was to summarize the effects of [18F]FDG-PET/CT on all-cause mortality and new diagnostic findingsin SAB.
METHODS
We systematically searched PubMed, EMBASE.com, Web of Science, and Wiley's Cochrane library from inception to 29 January 2021. Eligible studies were randomized controlled trials, clinically controlled trials, prospective and retrospective cohort studies, and case-control studies investigating the effects of [18F]FDG-PET/CT in hospitalized adult patients with SAB. We excluded studies lacking a control group without [18F]FDG-PET/CT. Risk of bias was assessed using the ROBINS-I tool and certainty of evidence using the GRADE approach by two independent reviewers.
RESULTS
We identified 1956 studies, of which five were included in our qualitative synthesis, including a total of 880 SAB patients. All studies were non-randomized and at moderate or serious risk of bias. Four studies, including a total of 804 patients, reported lower mortality in SAB patients that underwent [18F]FDG-PET/CT. One study including 102 patients reported more detected metastatic foci in the participants in whom [18F]FDG-PET/CT was performed.
DISCUSSION
We found low certainty of evidence that [18F]FDG-PET/CT reduces mortality in patients with SAB. This effect is possibly explained by a higher frequency of findings guiding optimal antibiotic treatment and source control interventions.
Topics: Adult; Bacteremia; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Staphylococcus aureus
PubMed: 35331165
DOI: 10.1186/s12879-022-07273-x -
European Journal of Medical Research Jan 2023To compare the detection rates of [Ga]Ga-FAPI-04 PET MRI/CT vs. [F]-FDG PET MRI/CT in gastric cancer. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the detection rates of [Ga]Ga-FAPI-04 PET MRI/CT vs. [F]-FDG PET MRI/CT in gastric cancer.
METHODS
An extensive librarian-led literature search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov was performed. The primary outcomes were sensitivity in patient-based evaluations, detection of lymph node metastases, and peritoneal involvement.
RESULTS
Five studies, including 148 participants, were analyzed. [Ga]Ga-FAPI-04 PET MRI/CT has a comparatively high sensitivity in patient-based evaluations compared with [F]-FDG PET MRI/CT (risk difference = 0.16, 95% CI 0.09-0.22, P < 0.00001). The [Ga]Ga-FAPI-04 PET MRI/CT group has a comparatively higher sensitivity in detecting lymph node metastases (RR = 0.15, 95% CI 0.01-0.29, P = 0.04), peritoneal involvement (RR = 0.55, 95% CI 0.38-0.72, P < 0.00001) in gastric cancer than [F]-FDG PET MRI/CT group.
CONCLUSIONS
This systematic review confirmed the advantage of [Ga]Ga-FAPI-04 PET MRI/CT in gastric cancer. [Ga]Ga-FAPI-04 PET MRI/CT was superior to [F]-FDG PET MRI/CT in detecting the primary tumor, lymph node metastases, and peritoneal metastases. More studies are needed for the sensitivity and specificity of [Ga]Ga-FAPI-04 PET MRI/CT in different pathological types of gastric cancer.
Topics: Humans; Fluorodeoxyglucose F18; Gallium Radioisotopes; Stomach Neoplasms; Lymphatic Metastasis; Positron Emission Tomography Computed Tomography; Magnetic Resonance Imaging; Carcinoma
PubMed: 36653862
DOI: 10.1186/s40001-023-00997-9