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AJR. American Journal of Roentgenology Apr 2023FDG PET/CT has limited diagnostic performance in the detection of peritoneal metastasis (PM). Gallium-68-labeled fibroblast activation protein inhibitor (FAPI) targets... (Meta-Analysis)
Meta-Analysis Review
FDG PET/CT has limited diagnostic performance in the detection of peritoneal metastasis (PM). Gallium-68-labeled fibroblast activation protein inhibitor (FAPI) targets tumor stroma, leading to high accumulation across cancer types. The purpose of this study was to conduct a meta-analysis to compare the diagnostic performances of Ga-FAPI PET/CT and FDG PET/CT in detecting PM on the basis of studies providing head-to-head comparisons between the two tests. PubMed, Embase, and Cochrane Library databases were searched through July 2022 to identify studies reporting head-to-head comparison of Ga-FAPI PET/CT and FDG PET/CT for detection of PM. The reference standard was classified as histopathology for all patients or as a combination of histopathologic, clinical, imaging, laboratory, and follow-up information (multidisciplinary reference standard). A random-effects statistical model was applied to conduct a meta-analysis of the diagnostic performances of the tests in patient-based and lesion-based analyses. The QUADAS-2 and QUADAS Comparative tools were used to assess study quality. Eleven studies were included. Patient-based analysis was reported in nine studies including 340 patients, and lesion-based analysis was reported in four studies including 222 lesions. The pooled sensitivity of Ga-FAPI PET/CT was significantly higher than that of FDG PET/CT in patient-based analysis (98.2% [95% CI, 96.1-100.0%] vs 55.9% [95% CI, 33.9-77.9%]) and lesion-based analysis (99.9% [95% CI, 99.5-100.0%] vs 27.3% [95% CI, 11.2-43.4%]). Eight studies were rated at high risk of bias in the reference standard domain because the multidisciplinary reference standard was not sufficiently explained and may have included one of the two index tests, which would have artificially increased sensitivity. In three studies specificity was reported as 100.0% for both tests; these studies were considered at uncertain risk of bias in the patient selection domain because patients with benign peritoneal conditions may have been excluded, resulting in underestimation of potential false-positive results. The current evidence suggests excellent sensitivity of Ga-FAPI PET/CT for the detection of PM in comparison with poorer sensitivity of FDG PET/CT. However, most included studies had high risk of bias. Further studies are needed to more convincingly characterize true- and false-positive results. The sensitivity of Ga-FAPI PET/CT may be substantially greater than that of FDG PET/CT for the evaluation of PM, facilitating surgical planning and candidate selection.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Peritoneal Neoplasms; Gallium Radioisotopes; Positron-Emission Tomography
PubMed: 36321984
DOI: 10.2214/AJR.22.28402 -
Current Oncology (Toronto, Ont.) Oct 2022The present study aimed to assess the existing data about Primary Adrenal Lymphoma (PAL) evaluated with FDG PET and to describe a small monocentric series of cases. A... (Review)
Review
The present study aimed to assess the existing data about Primary Adrenal Lymphoma (PAL) evaluated with FDG PET and to describe a small monocentric series of cases. A systematic analysis (from 2010 to 2022) was made by using PubMed and Web of Science databases reporting data about the role of FDG PET/CT in patients with suspicious or known adrenal lymphoma. The quality of the papers was assessed by using QUADAS-2 criteria. Moreover, from a single institutional collection between 2010 and 2021, data from patients affected by adrenal lymphoma and undergoing contrast-enhanced compute tomography (ceCT)/magnetic resonance (MR) and FDG PET/CT or PET/MR were retrieved and singularly described. Seventy-eight papers were available from PubMed and 25 from Web of Science. Forty-seven (Nr. 47) Patients were studied, most of them in the initial staging of disease ( = 42; 90%). Only in one paper, the scan was made before and after therapy. The selected clinical cases were relative to the initial staging of disease, the restaging, and the evaluation of response to therapy. PET/CT and PET/MR always showed a high FDG uptake in the primary adrenal lesions and in metastatic sites. Moreover, PET metrics, such as maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV), were elevated in all primary adrenal lesions. In conclusions, FDG PET either coupled with CT or MRI can be useful in staging, restaging, and for the evaluation of treatment response in patients affected by PAL.
Topics: Humans; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Lymphoma; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy
PubMed: 36290900
DOI: 10.3390/curroncol29100623 -
Medicine Sep 2022The current systematic review and meta-analysis explored the value of metabolic tumor volume (MTV) as well as total lesion glycolysis (TLG) in predicting the prognosis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The current systematic review and meta-analysis explored the value of metabolic tumor volume (MTV) as well as total lesion glycolysis (TLG) in predicting the prognosis of head and neck squamous cell carcinoma (HNSCC) using 18 F-FDG PET parameters.
METHODS
This work identified relevant studies in the English language by searching several electronic databases, like Cochrane Library, EMBASE, and PubMed. In addition, pooled hazard ratios (HRs) were also calculated to analyze whether MTV and TLG were significant in predicting prognosis.
RESULTS
The present study included 15 primary studies involving HNSCC cases. As for the elevated TLG, it attained the pooled HR of 1.85 (95% confidence interval [CI], 1.16-2.94; P = .000; I2 = 78.3%) in predicting overall survival (OS), whereas that for elevated MTV was1.22 (95%CI, 1.09-1.36; P = .000; I2 = 82.4%). Besides, for elevated MTV, it attained the pooled HR of 1.34 (95%CI, 1.15-1.56, P = .000; I2 = 86.0%) in predicting disease-free survival (DFS); while the elevated TLG was related to DFS. Sensitivity analysis confirmed that our results are reliable. As for MTV, the ROC-stratified subgroups for DFS and multivariate analyses-stratified subgroups for OS showed statistically significant differences, with no obvious heterogeneities across different studies. For TLG, other methods-stratified subgroups for OS showed statistically significant differences, with no obvious heterogeneity across different studies.
CONCLUSION
This work indicated that PET/CT is of predictive significance across HNSCC cases. Although the included articles used different methods and recruited HNSCC cases with high clinical heterogeneity; however, our findings confirmed that an elevated MTV can predict the increased risk of side reactions or even death among HNSCC cases and that an elevated TLG can predict a higher death risk.
Topics: Fluorodeoxyglucose F18; Glycolysis; Head and Neck Neoplasms; Humans; Positron Emission Tomography Computed Tomography; Prognosis; Radiopharmaceuticals; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Tumor Burden
PubMed: 36181127
DOI: 10.1097/MD.0000000000030798 -
The British Journal of Radiology Oct 2022CT and staging laparoscopy are routinely used to stage patients with gastric cancer, however the role of F-fluorodeoxyglucose (FDG) positron emission tomography (PET)...
OBJECTIVE
CT and staging laparoscopy are routinely used to stage patients with gastric cancer, however the role of F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with CT (PET-CT) is uncertain. This systematic review synthesised the evidence regarding the impact of baseline PET-CT staging on treatment decisions and patient outcomes.
METHODS
Systematic database searches were performed without date restriction. Studies reporting data in patients with gastric adenocarcinoma who underwent radiological staging were included. One reviewer screened titles and abstracts for suitability and two reviewers extracted data from included articles. Primary outcome was the reported change in management after PET-CT. Secondary outcomes were the rates of recurrence and overall survival between patients staged with and without PET-CT. Risk of bias was assessed using the ROBINS-I tool. PROSPERO registration (CRD42022304314).
RESULTS
Data from 11 studies recruiting 2101 patients between 2012 and 2021 were included. PET-CT was performed in 1422 patients. Change of management varied between 3% and 29% of cases. No studies compared recurrence or survival rates between patients staged with or without PET-CT. Adenocarcinoma of intestinal subtype tended to be more FDG-avid compared to diffuse or signet-ring subtypes. No randomised data existed, and studies were considered low quality with high risk of bias.
CONCLUSION
Evidence for the additional value of PET-CT in the gastric cancer staging pathway is limited. All studies reported a positive impact by preventing those with undetected metastatic disease on CT undergoing futile surgery. Future national guidelines should consider routine staging PET-CT in gastric cancer.
ADVANCES IN KNOWLEDGE
Studies indicated that FDG PET-CT added benefit in gastric cancer staging by detecting more distant metastases, but these studies were generally of low quality and at high risk of bias. Intestinal subtype of gastric adenocarcinoma tended to be more FDG-avid and therefore more distant metastases were subsequently detected.
Topics: Humans; Fluorodeoxyglucose F18; Stomach Neoplasms; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Adenocarcinoma; Neoplasm Staging; Radiopharmaceuticals; Retrospective Studies
PubMed: 36129138
DOI: 10.1259/bjr.20220437 -
Diseases of the Colon and Rectum Dec 2022Different techniques exist for the imaging of lateral lymph nodes in rectal cancer. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Different techniques exist for the imaging of lateral lymph nodes in rectal cancer.
OBJECTIVE
This study aimed to compare the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the identification of lateral lymph node metastases in rectal cancer.
DATA SOURCES
Data sources include PubMed, Embase, Cochrane Library, and Google Scholar.
STUDY SELECTION
All studies evaluating the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the preoperative detection of lateral lymph node metastasis in patients with rectal cancer were selected.
INTERVENTIONS
The interventions were pelvic MRI, 18 F-FDG-PET/CT, and/or 18 F-FDG-PET/MRI.
MAIN OUTCOME MEASURES
Definitive histopathology was used as a criterion standard.
RESULTS
A total of 20 studies (1,827 patients) were included out of an initial search yielding 7,360 studies. The pooled sensitivity of pelvic MRI was 0.88 (95% CI, 0.85-0.91), of 18 F-FDG-PET/CT was 0.83 (95% CI, 0.80-0.86), and of 18 F-FDG-PET/MRI was 0.72 (95% CI, 0.51-0.87) for the detection of lateral lymph node metastasis. The pooled specificity of pelvic MRI was 0.85 (95% CI, 0.78-0.90), of 18 F-FDG-PET/CT was 0.95 (95% CI, 0.86-0.98), and of 18 F-FDG-PET/MRI was 0.90 (95% CI, 0.78-0.96). The area under the curve was 0.88 (95% CI, 0.85-0.91) for pelvic MRI and was 0.83 (95% CI, 0.80-0.86) for 18 F-FDG-PET/CT.
LIMITATIONS
Heterogeneity in terms of patients' populations, definitions of suspect lateral lymph nodes, and administration of neoadjuvant treatment.
CONCLUSIONS
For the preoperative identification of lateral lymph node metastasis in rectal cancer, this review found compelling evidence that pelvic MRI should constitute the imaging modality of choice. In contrast, to confirm the presence of lateral lymph node metastasis, 18 F-FDG-PET/MRI modalities allow discarding false positive cases because of increased specificity.
PROSPERO REGISTRATION NUMBER
CRD42020200319.
Topics: Humans; Lymphatic Metastasis; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Diagnostic Tests, Routine; Sensitivity and Specificity; Lymph Nodes; Positron-Emission Tomography; Rectal Neoplasms
PubMed: 36102825
DOI: 10.1097/DCR.0000000000002537 -
Journal of Cardiac Surgery Nov 2022The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortovascular surgery. However, although... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortovascular surgery. However, although FET yields excellent results, the risk of certain complications requiring secondary intervention remains present, negating its one-step hybrid advantage over conventional techniques. This systematic review and meta-analysis sought to evaluate controversies regarding the incidence of FET-related complications, with a focus on aortic remodeling, distal stent-graft induced new entry (dSINE) and endoleak, in patients with type A aortic dissection (TAAD) and/or thoracic aortic aneurysm.
MATERIALS AND METHODS
A comprehensive literature search was conducted using multiple electronic databases including EMBASE, Scopus, and PubMed/MEDLINE to identify evidence on TAR with FET in patients with TAAD and/or aneurysm. Studies published up until January 2022 were included, and after applying exclusion criteria, a total of 43 studies were extracted.
RESULTS
A total of 5068 patients who underwent FET procedure were included. The pooled estimates of dSINE and endoleak were 2% (95% confidence interval [CI] 0.01-0.06, I = 78%) and 3% (95% CI 0.01-0.11, I = 89%), respectively. The pooled rate of secondary thoracic endovascular aortic repair (TEVAR) post-FET was 7% (95% CI 0.05-0.12, I = 89%) while the pooled rate of false lumen thrombosis at the level of stent-graft was 91% (95% CI 0.75-0.97, I = 92%). After subgroup analysis, heterogeneity for distal stent-graft induced new entry (dSINE) and endoleak resolved among European patients, where Thoraflex Hybrid (THP) and E-Vita stent-grafts were used (both I = 0%). In addition, heterogeneity for secondary TEVAR after FET resolved among Asians receiving Cronus (I = 15.1%) and Frozenix stent-grafts (I = 1%).
CONCLUSION
Our results showed that the FET procedure in patients with TAAD and/or aneurysm is associated with excellent results, with a particularly low incidence of dSINE and endoleak as well as highly favorable aortic remodeling. However the type of stent-graft and the study location were sources of heterogeneity, emphasizing the need for multicenter studies directly comparing FET grafts. Finally, THP can be considered the primary FET device choice due to its superior results.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Azides; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Deoxyglucose; Endoleak; Humans; Retrospective Studies; Stents; Treatment Outcome
PubMed: 36069163
DOI: 10.1111/jocs.16918 -
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 -
Current Medical Imaging 2022The Non-Small Cell Variant of Lung Cancer (NSCLC) has a poorer prognosis. It is typically diagnosed through non-invasive imaging. Of particular note has been FDGPET/ CT,... (Meta-Analysis)
Meta-Analysis
Diagnostic Accuracy of F18-fluorodeoxyglucose Positron Emission Tomography- computed Tomography for the Detection of Non-small Cell Lung Cancer Recurrence: A Systematic Review and Meta-analysis.
BACKGROUND
The Non-Small Cell Variant of Lung Cancer (NSCLC) has a poorer prognosis. It is typically diagnosed through non-invasive imaging. Of particular note has been FDGPET/ CT, which has been investigated across various settings with differing results.
OBJECTIVE
This study is to pool the available information on the diagnostic performance of 18-F FDG PET/CT for detecting NSCLC recurrence.
METHODS
A systematic literature search was conducted across electronic databases for studies published before May 2021. The QUADAS tool was applied to assess study quality, and a metaanalysis was performed to retrieve pooled estimates. Chi-squared tests and I2 statistics were used to assess heterogeneity. Egger's test and funnel plots were used to assess publication bias.
RESULTS
The literature search yielded 20 studies featuring data on 1,973 patients. The majority of the studies had a low bias risk. The pooled sensitivity and specificity were 96% (95% CI: 91%- 98%) and 93% (95% CI: 89%-95%), respectively. The LRP and LRN estimates were in the left upper quadrant of the LR scattergram, indicating that F18-FDG PET/CT can be utilized for both confirmation and exclusion. The AUC was 0.98 (95% CI: 0.92-0.99). Fagan's nomogram showed that F18-FDG PET/CT had good clinical utility for recurrent NSCLC diagnosis. There was considerable between-study variability (p=0.02). The funnel plot was asymmetrical, indicating the possibility of publication bias.
CONCLUSION
This meta-analysis found FDG-PET/CT to be highly accurate for identifying NSCLC recurrence. However, more studies assessing this modality across different patient situations are required to strengthen the argument for changing international guidelines and practices.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Carcinoma, Non-Small-Cell Lung; Radiopharmaceuticals; Lung Neoplasms; Tomography, X-Ray Computed; Positron-Emission Tomography
PubMed: 35927894
DOI: 10.2174/1573405618666220802101446 -
Seminars in Arthritis and Rheumatism Oct 2022To conduct a systematic literature review and meta-analysis to estimate the proportion of fever of unknown origin (FUO) and inflammation of unknown origin (IUO) cases... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To conduct a systematic literature review and meta-analysis to estimate the proportion of fever of unknown origin (FUO) and inflammation of unknown origin (IUO) cases that are due to rheumatic disorders and the relative frequency of specific entities associated with FUO/IUO.
METHODS
We searched PubMed and EMBASE between January 1, 2002, and December 31, 2021, for studies with ≥50 patients reporting on causes of FUO/IUO. The primary outcome was the proportion of FUO/IUO patients with rheumatic disease. Secondary outcomes include the association between study and patient characteristics and the proportion of rheumatic disease in addition to the relative frequency of rheumatic disorders within this group. Proportion estimates were calculated using random-effects models.
RESULTS
The included studies represented 16884 patients with FUO/IUO. Rheumatic disease explained 22.2% (95%CI 19.6 - 25.0%) of cases. Adult-onset Still's disease (22.8% [95%CI 18.4-27.9%]), giant cell arteritis (11.4% [95%CI 8.0-16.3%]), and systemic lupus erythematosus (11.1% [95%CI 9.0-13.8%]) were the most frequent disorders. The proportion of rheumatic disorders was significantly higher in high-income countries (25.9% [95%CI 21.5 - 30.8%]) versus middle-income countries (19.5% [95%CI 16.7 - 22.7%]) and in prospective studies (27.0% [95%CI 21.9-32.8%]) versus retrospective studies (20.6% [95%CI 18.1-24.0%]). Multivariable meta-regression analysis demonstrated that rheumatic disease was associated with the fever duration (0.011 [95%CI 0.003-0.021]; P=0.01) and with the fraction of patients with IUO (1.05 [95%CI 0.41-1.68]; P=0.002).
CONCLUSION
Rheumatic disorders are a common cause of FUO/IUO. The care of patients with FUO/IUO should involve physicians who are familiar with the diagnostic workup of rheumatic disease.
Topics: Adult; Fever of Unknown Origin; Fluorodeoxyglucose F18; Humans; Inflammation; Prospective Studies; Retrospective Studies; Rheumatic Diseases
PubMed: 35868032
DOI: 10.1016/j.semarthrit.2022.152066 -
Clinical Nuclear Medicine Oct 2022The purpose of the current study was to evaluate the diagnostic accuracies of 18 F-FDG PET or PET/CT for diagnosis of Merkel cell carcinoma (MCC) through a systematic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of the current study was to evaluate the diagnostic accuracies of 18 F-FDG PET or PET/CT for diagnosis of Merkel cell carcinoma (MCC) through a systematic review and meta-analysis.
METHODS
The PubMed, Cochrane database, and EMBASE database, from January 1990 to January 31, 2022, were searched for studies evaluating diagnostic performance of 18 F-FDG PET or PET/CT for MCC. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves.
RESULTS
Across 9 studies (259 patients), the pooled sensitivity of 18 F-FDG PET or PET/CT was 0.91 (95% confidence interval [CI], 0.85-0.95) and a pooled specificity of 0.93 (95% CI, 0.86-0.97). Likelihood ratio syntheses gave an overall LR+ of 14.0 (95% CI, 6.6-29.6) and LR- of 0.09 (95% CI, 0.05-0.17). The pooled diagnostic odds ratio was 153 (95% CI, 57-416).
CONCLUSION
18 F-FDG PET/CT showed an excellent performance for diagnosis of MCC. The likelihood ratio scattergram indicated that 18 F-FDG PET or PET/CT is useful for exclusion and confirmation of MCC. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of 18 F-FDG PET or PET/CT for MCC patients.
Topics: Carcinoma, Merkel Cell; Diagnostic Tests, Routine; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Skin Neoplasms
PubMed: 35777979
DOI: 10.1097/RLU.0000000000004321