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The British Journal of Radiology Apr 2021This study compared the diagnostic performance of three different imaging modalities for preoperative lymph node (LN) staging in thyroid cancer patients, using a network... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study compared the diagnostic performance of three different imaging modalities for preoperative lymph node (LN) staging in thyroid cancer patients, using a network meta-analysis (NMA).
METHODS
PubMed and Embase were searched to identify studies evaluating the performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET or PET/CT), computed tomography (CT), and ultrasonography (US) for preoperative LN staging in thyroid cancer patients. The NMA included both patient- and lesion-based analyses. The surface under the cumulative ranking curve (SUCRA) values was used to decide on the most effective diagnostic method.
RESULTS
A total of 3,571 patients from 19 direct comparison studies using three different imaging modalities for preoperative LN staging in thyroid cancer patients were included. US showed the highest SUCRA values for positive predictive values (PPV), negative predictive values (NPV), and accuracy in detection of all cervical LN metastasis. F-18 FDG PET or PET/CT and US showed the highest SUCRA values for PPV and sensitivity, respectively, for central LN, and the highest SUCRA value of specificity and sensitivity, respectively, for lateral LN.
CONCLUSION
The results from this NMA indicate that F-18 FDG PET or PET/CT, CT, and US have complementary diagnostic roles for preoperative staging in thyroid cancer patients.
ADVANCES IN KNOWLEDGE
Using NMA, we comprehensively compared the different diagnostic values and limitations of F-18 FDG PET or PET/CT, CT, and US for the preoperative LN staging in thyroid cancer patients.
Topics: Fluorodeoxyglucose F18; Humans; Lymph Nodes; Lymphatic Metastasis; Neck; Neoplasm Staging; Network Meta-Analysis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Preoperative Care; Thyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography
PubMed: 33595337
DOI: 10.1259/bjr.20201076 -
The American Journal of Tropical... Jan 2021The diagnosis of visceral leishmaniasis (VL) is complicated and often unsuspected. Little is known of the usefulness of nuclear imaging in VL. Our objective was to...
The diagnosis of visceral leishmaniasis (VL) is complicated and often unsuspected. Little is known of the usefulness of nuclear imaging in VL. Our objective was to describe findings seen in fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in cases of VL. We retrospectively reviewed VL cases diagnosed at Vall d'Hebron University Hospital from May 2012 to May 2018 and selected those that had an FDG-PET/CT performed. Information on procedures and details of the FDG-PET/CT features and follow-up were collected. We then systematically reviewed the literature on VL and FDG-PET/CT. Four of 43 patients diagnosed with VL had an FDG-PET/CT performed. All four patients presented diffuse splenic uptake of FDG-PET/CT. Adenopathy was not always present, and bone marrow uptake was found in two patients. A posttreatment FDG-PET/CT in one patient revealed normalization of initial findings. In the literature review, 43 of 50 cases presented similar splenic uptake in the PET/CT, being described as different patterns: "increased metabolism," "homogeneous," "diffuse," "diffuse and multifocal," "nodular," "patchy and granular," "subcortical," and "compatible with lymphoma." Other frequent findings were bone marrow uptake and adenopathies. We, therefore, conclude that FDG-PET/CT could become a useful tool for the diagnosis and follow-up of VL and that VL should be taken into account in patients with fever of unknown origin with enhanced splenic uptake in FDG-PET/CT. Differential diagnosis in these cases should be made with splenic primary lymphoma, virus infections, chemotherapy, and colony-stimulating factor therapy. Further structured studies with more cases are needed to define its diagnostic and prognostic value.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Fluorodeoxyglucose F18; Humans; Leishmania donovani; Leishmaniasis, Visceral; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Retrospective Studies; Spain; Ultrasonography; Young Adult
PubMed: 33534763
DOI: 10.4269/ajtmh.19-0858 -
In Vivo (Athens, Greece) 2021Axillary lymph node (ALN) status plays a key role in the staging of breast cancer. Positron Emission Tomography/Computed Tomography (PET/CT) using 18-Fluorodeoxyglucose... (Review)
Review
BACKGROUND/AIM
Axillary lymph node (ALN) status plays a key role in the staging of breast cancer. Positron Emission Tomography/Computed Tomography (PET/CT) using 18-Fluorodeoxyglucose (FDG) can visualise ALN metastasis. However, its utility compared to current methods is unclear. We systematically reviewed the role of FDG PET/CT in breast cancer staging.
MATERIALS AND METHODS
PubMed, Ovid and Cochrane were searched systematically up until August 2020. Included papers had true positive (TP), false positive (FP), true negative (TN) and false negative (FN) rates, sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV).
RESULTS
Nine studies (n=1486) were included, showing: i) sensitivity=52.2%, ii) specificity=91.6%, iii) PPV=77.8%, iv) NPV=77.2, and v) accuracy=77.3%.
CONCLUSION
FDG-PET/CT has a low sensitivity but high specificity for ALN disease. Therefore, ultrasound-guided biopsy could be considered in a positive CT/PET. Modest accuracy prohibits the use of FDG-PET/CT alone in axillary staging. Prospective research using standardised protocols and quantitative cut-off points is warranted.
Topics: Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 33402446
DOI: 10.21873/invivo.12228 -
European Journal of Nuclear Medicine... Jun 2021Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR.
METHODS
PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model.
RESULTS
Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84-8.71), hips (LR+ 2.91; 95% CI 2.09-4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91-4.28), shoulders (LR+ 2.57; 95% CI 1.24-5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33-4.02). Negative likelihood ratios (LR-) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42-6.32) and LR- of 0.19 (95% CI 0.10-0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria.
CONCLUSION
Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR.
Topics: Fluorodeoxyglucose F18; Giant Cell Arteritis; Humans; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 33372248
DOI: 10.1007/s00259-020-05162-6 -
Neuro-oncology Apr 2021Malignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling errors and biopsies or resections are cumbersome and possibly damaging in benign peripheral nerve sheath tumor (BPNST). This study aimed to systematically review and quantify the diagnostic accuracy of noninvasive tests for distinguishing MPNST from BPNST.
METHODS
Studies on accuracy of MRI, FDG-PET (fluorodeoxyglucose positron emission tomography), and liquid biopsies were identified in PubMed and Embase from 2000 to 2019. Pooled accuracies were calculated using Bayesian bivariate meta-analyses. Individual level-patient data were analyzed for ideal maximum standardized uptake value (SUVmax) threshold on FDG-PET.
RESULTS
Forty-three studies were selected for qualitative synthesis including data on 1875 patients and 2939 lesions. Thirty-five studies were included for meta-analyses. For MRI, the absence of target sign showed highest sensitivity (0.99, 95% CI: 0.94-1.00); ill-defined margins (0.94, 95% CI: 0.88-0.98); and perilesional edema (0.95, 95% CI: 0.83-1.00) showed highest specificity. For FDG-PET, SUVmax and tumor-to-liver ratio show similar accuracy; sensitivity 0.94, 95% CI: 0.91-0.97 and 0.93, 95% CI: 0.87-0.97, respectively, specificity 0.81, 95% CI: 0.76-0.87 and 0.79, 95% CI: 0.70-0.86, respectively. SUVmax ≥3.5 yielded the best accuracy with a sensitivity of 0.99 (95% CI: 0.93-1.00) and specificity of 0.75 (95% CI: 0.56-0.90).
CONCLUSIONS
Biopsies may be omitted in the presence of a target sign and the absence of ill-defined margins or perilesional edema. Because of diverse radiological characteristics of MPNST, biopsies may still commonly be required. In neurofibromatosis type 1, FDG-PET scans may further reduce biopsies. Ideal SUVmax threshold is ≥3.5.
Topics: Bayes Theorem; Fluorodeoxyglucose F18; Humans; Nerve Sheath Neoplasms; Neurofibrosarcoma; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 33326583
DOI: 10.1093/neuonc/noaa280 -
Strahlentherapie Und Onkologie : Organ... Mar 2021Treatment of patients with laryngeal squamous cell carcinoma with radiotherapy or chemoradiation is an established alternative to laryngeal surgery in many cases, but...
PURPOSE
Treatment of patients with laryngeal squamous cell carcinoma with radiotherapy or chemoradiation is an established alternative to laryngeal surgery in many cases, but particularly for advanced tumors without cartilage invasion. Imaging modalities face the challenge of distinguishing between posttherapeutic changes and residual disease in the complex anatomic subsite of the larynx. Guidelines concerning restaging of head and neck squamous cell carcinomas (HNSCC) are presented by the National Comprehensive Cancer Network (NCCN) and other national guidelines, but clearly defined recommendations for routine restaging particularly for laryngeal cancer are lacking.
METHODS
A systematic search was carried out in PubMed to identify studies evaluating routine restaging methods after primary non-surgical treatment of laryngeal squamous cell carcinoma from 2009 to 2020.
RESULTS
Only three studies were deemed eligible, as they included at least ≥50% patients with laryngeal squamous cell carcinoma and evaluated imaging modalities to detect residual cancer. The small number of studies in our review suggest restaging with fluoro-deoxy-glucose positron-emission tomography/computed tomography (FDG PET/CT) 3 months after initial treatment, followed by direct laryngoscopy with biopsy of the lesions identified by FDG PET/CT.
CONCLUSION
Studies evaluating restaging methods after organ-preserving non-surgical treatment of laryngeal carcinoma are limited. As radiotherapy (RT), chemoradiotherapy (CRT), systemic therapy followed by RT and radioimmunotherapy are established alternatives to surgical treatment, particularly in advanced laryngeal cancers, further studies are needed to assess and compare different imaging modalities (e.g. PET/CT, MRI, CT, ultrasound) and clinical diagnostic tools (e.g., video laryngoscopy, direct laryngoscopy) to offer patients safe and efficient restaging strategies. PET or PET/CT 3 months after initial treatment followed by direct laryngoscopy with biopsy of the identified lesions has the potential to reduce the number of unnecessary laryngoscopies.
Topics: Biopsy; Carcinoma, Squamous Cell; Chemoradiotherapy; Fluorodeoxyglucose F18; Humans; Laryngeal Neoplasms; Laryngoscopy; Larynx; Neoplasm Staging; Positron Emission Tomography Computed Tomography
PubMed: 33216194
DOI: 10.1007/s00066-020-01706-9 -
Journal of Neuroimaging : Official... Jan 2021World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity,... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
World Health Organization (WHO) grading of meningiomas reflects recurrence rate and prognosis. Positron emission tomography (PET) investigates metabolic activity, allowing for distinction between low- and high-grade tumors. As preoperative suspicion for malignant meningioma will influence surgical strategy in terms of timing, extent of resection, and risks taken to achieve a total resection, we systematically reviewed the literature on PET-imaging in meningiomas and relate these findings to histopathological analysis.
METHODS
Searches in PubMed, EMBASE, and The Cochrane Library, from inception to September 2019, included studies of patients who had undergone surgery for a histologically verified intracranial meningioma, with a PET-scan prior to surgery and description of (semi)quantitative PET values for meningiomas from two different WHO groups. Studies comparing more than 1 patient per WHO group were included in the meta-analysis.
RESULTS
Twenty-two studies (432 patients) were included. 18fluor-fluorodesoxyglucose (18F-FDG) PET was mostly described to differentiate benign from malignant meningiomas. Pooled data showed differences in mean (95% CI) Standardized Uptake Value (SUV) for WHO II/III compared to WHO I of 2.51 (1.36, 3.66), and in tumor-to-normal (T/N) ratio (T/N ratio) for WHO II/III versus WHO I of .42 (.12, .73).
CONCLUSIONS
We found that SUV and T/N ratio in 18F-FDG PET may be useful to noninvasively differentiate benign from malignant meningiomas. T/N ratio seems to have a high specificity for the detection of high-grade meningiomas. Other PET tracers were studied too infrequently to draw definitive conclusions. Before treatment strategies can be adapted based on 18F-FDG PET, prospective studies in larger cohorts are warranted to validate the optimal T/N ratio cutoff point.
Topics: Fluorodeoxyglucose F18; Humans; Meningeal Neoplasms; Meningioma; Positron-Emission Tomography; Prognosis; World Health Organization
PubMed: 33135239
DOI: 10.1111/jon.12795 -
Breast Cancer Research : BCR Oct 2020We performed a systematic review and meta-analysis to evaluate the prognostic significance of F-FDG PET and PET/CT for evaluation of responses to neoadjuvant... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We performed a systematic review and meta-analysis to evaluate the prognostic significance of F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients.
METHODS
We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model.
RESULTS
Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14-0.32) for interim PET scans and 0.31 (95% CI, 0.21-0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09-0.44) and 0.26 (95% CI, 0.14-0.51), respectively.
CONCLUSIONS
The currently available literature suggests that the use of F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Disease Progression; Female; Fluorodeoxyglucose F18; Humans; Neoadjuvant Therapy; Positron Emission Tomography Computed Tomography; Prognosis; Radiopharmaceuticals; Survival Rate
PubMed: 33129348
DOI: 10.1186/s13058-020-01350-2 -
Thoracic Cancer Nov 2020The purpose of the current study was to investigate the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for... (Meta-Analysis)
Meta-Analysis
Predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for PD-L1 expression in non-small cell lung cancer: A systematic review and meta-analysis.
BACKGROUND
The purpose of the current study was to investigate the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for programmed death ligand 1 (PD-L1) in non-small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis.
METHODS
The PubMed, Cochrane, and EMBASE database, from the earliest available date of indexing through 30 April 2020, were searched for studies evaluating the diagnostic performance of 18F-FDG PET/CT for prediction of PD-L1 expression in NSCLC patients.
RESULTS
Across six studies (1739 patients), the pooled sensitivity for 18F-FDG PET/CT was 0.72 (95% CI: 0.58-0.82) with heterogeneity (I = 90.9, P < 0.001) and a pooled specificity of 0.69 (95% CI: 0.64-0.74) with heterogeneity (I = 77.9, P < 0.001). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR +) of 2.3 (95% CI: 1.8-2.9) and negative likelihood ratio (LR-) of 0.41 (95% CI: 0.26-0.63). The pooled diagnostic odds ratio (DOR) was six (95% CI: 3-11). Hierarchical summary receiver operating characteristic (ROC) curve indicated that the area under the curve was 0.74 (95% CI: 0.70-0.78).
CONCLUSIONS
The current meta-analysis showed a moderate sensitivity and specificity of 18F-FDG PET/CT for the prediction of PD-L1 expression in NSCLC patients. The DOR was low and the likelihood ratio scatter-gram indicated that 18F-FDG PET/CT might not be useful for the prediction of PD-L1 expression in NSCLC patients and not for its exclusion.
KEY POINTS
Significant findings of the study The current meta-analysis showed a moderate sensitivity and specificity of 18F-FDG PET/CT for the prediction of PD-L1 expression in NSCLC patients. The DOR was low and the likelihood ratio scattergram indicated that 18F-FDG PET/CT might not be useful for the prediction of PD-L1 expression in NSCLC patients and not for its exclusion. What this study adds This study concluded that the role of 18F-FDG PET/CT in predicting tumor expression of PD-L1 should be further elucidated.
Topics: B7-H1 Antigen; Carcinoma, Non-Small-Cell Lung; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Positron Emission Tomography Computed Tomography
PubMed: 32951338
DOI: 10.1111/1759-7714.13664 -
Gynecologic Oncology Nov 2020Imaging is essential in detecting lymph node metastases for radiotherapy treatment planning in locally advanced cervical cancer (LACC). There are not many data on the...
PURPOSE
Imaging is essential in detecting lymph node metastases for radiotherapy treatment planning in locally advanced cervical cancer (LACC). There are not many data on the performance of [F]FDG-PET(CT) in showing lymph node metastases in LACC. We pooled sensitivity and specificity of [F]FDG-PET(CT) for detecting pelvic and/or para-aortic lymph node metastases in patients with LACC. Also, the positive and negative posttest probabilities at high and low levels of prevalence were determined.
METHODS
MEDLINE and EMBASE searches were performed and quality characteristics assessed. Logit-sensitivity and logit-specificity estimates with corresponding standard errors were calculated. Summary estimates of sensitivity and specificity with corresponding 95% confidence intervals (CIs) were calculated by anti-logit transformation. Positive and negative likelihood ratios (LRs) were calculated from the mean logit-sensitivity and mean logit-specificity and the corresponding standard errors. The posttest probabilities were determined by Bayesian approach.
RESULTS
Twelve studies were included with a total of 778 patients aged 10-85 years. For pelvic nodes, summary estimates of sensitivity, specificity, LR+ and LR- were: 0.88 (95%CI: 0.40-0.99), 0.93 (95%CI: 0.85-0.97), 11.90 (95%CI: 5.32-26.62) and 0.13 (95%CI: 0.01-1.08). At the lowest prevalence of 0.15 the positive predictive value (PPV) and negative predictive value (NPV) were 0.68 and 0.98, at the highest prevalence of 0.65, 0.96 and 0.81. For the para-aortic nodes, the summary estimates of sensitivity, specificity LR+ and LR- were: 0.40 (95%CI: 0.18-0.66), 0.93 (95%CI: 0.91-0.95), 6.08 (95%CI: 2.90-12.78) and 0.64 (95%CI: 0.42-0.99), respectively. At the lowest prevalence of 0.17 the PPV and NPV were 0.55 and 0.88, at the highest prevalence of 0.50, 0.86 and 0.61.
CONCLUSION
The PPV and NPV of [F]FDG-PET(CT) showing lymph node metastases in patients with LACC improves with higher prevalence. Prevalence and predictive values should be taken into account when determining therapeutic strategies based on [F]FDG-PET(CT).
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Middle Aged; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Uterine Cervical Neoplasms; Young Adult
PubMed: 32921477
DOI: 10.1016/j.ygyno.2020.08.021