Performance of Whole-Body PET/CT for the Detection of Distant Malignancies in Various Cancers: A Systematic Review and Meta-Analysis
ABSTRACT At present, there is no ideal imaging modality for the diagnosis of distant metastases and second primary cancers in cancer patients. We aimed to assess the accuracy of whole-body PET/CT for the overall assessment of distant malignancies in patients with various cancers. METHODS: Studies about whole-body PET/CT for the detection of distant malignancies in cancer patients were systematically searched in MEDLINE and EMBASE. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and constructed summary receiver operating characteristic curves using hierarchical regression models for whole-body PET/CT. RESULTS: Across 41 studies (4,305 patients), the sensitivity and specificity of whole-body PET/CT were 0.93 (95% confidence interval [CI], 0.88-0.96) and 0.96 (95% CI, 0.95-0.96), respectively. Subgroup analysis showed that the sensitivity and specificity of whole-body PET/CT for various cancers, respectively, were as follows: head and neck cancer, 0.90 (95% CI, 0.83-0.95) and 0.95 (95% CI, 0.94-0.96); lung cancer, 0.91 (95% CI, 0.76-0.97) and 0.96 (95% CI, 0.94-0.98); breast cancer, 0.97 (95% CI, 0.93-0.99) and 0.95 (95% CI, 0.90-0.97); and cancer of digestive system, 0.92 (95% CI, 0.68-0.98) and 0.97 (95% CI, 0.91-0.99). CONCLUSION: Whole-body PET/CT has excellent diagnostic performance for the overall assessment of distant malignancies in patients with various cancers, especially head and neck cancer, breast cancer, and lung cancer.
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ABSTRACT: A pulmonary lesion is an extremely common and clinically challenging disorder worldwide, and an accurate diagnosis of lung cancer is crucial for early treatment and management. The aim of the present study was to perform a comprehensive meta analysis to compare the diagnostic performance of (18)F-fluorothymidine ((18)F-FLT) positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG) PET in evaluating patients with pulmonary lesions. Relevant studies were identified using the PubMed, EMBASE and Cochrane library databases. The pooled estimated sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and diagnostic odds ratio (DOR) for (18)F-FLT PET versus (18)F-FDG PET were calculated as the main outcome measures. Summary receiver operating characteristic curves were also constructed by Meta-Disk 1.4 software using a Mose's constant of linear model. The meta analysis showed that (18)F-FLT PET had a higher specificity (0.70; 95% CI, 0.61-0.77), but lower sensitivity (0.81; 95% CI, 0.74-0.87) compared to (18)F-FDG PET (0.50; 95% CI, 0.41-0.58 for specificity; 0.92; 95% CI 0.86-0.95 for sensitivity). For DOR, (18)F-FLT PET (12.58; 95% CI, 6.81-23.24) was higher compared to (18)F-FDG PET (10.72; 95% CI, 5.51-20.87). The area under the curve was 0.8592 and 0.9240 for (18)F-FLT PET and (18)F-FDG PET, respectively (Z=0.976, P>0.05). In conclusion, (18)F-FLT PET and (18)F-FDG PET had good diagnostic performance for the overall assessment of pulmonary lesions, and (18)F-FLT PET had a higher specificity compared to (18)F-FDG PET, but was less sensitive than (18)F-FDG PET. Therefore, (18)F-FLT and (18)F-FDG together could add diagnostic confidence for pulmonary lesions.Molecular and Clinical Oncology 01/2015; 3(1):101-108. DOI:10.3892/mco.2014.440
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ABSTRACT: Definitive clinical trials of new chemotherapies for treating tuberculosis (TB) require following subjects until at least 6 months after treatment discontinuation to assess for durable cure, making these trials expensive and lengthy. Surrogate endpoints relating to treatment failure and relapse are currently limited to sputum microbiology, which has limited sensitivity and specificity. We prospectively assessed radiographic changes using 2-deoxy-2-[(18)F]-fluoro-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) at 2 and 6 months (CT only) in a cohort of subjects with multidrug-resistant TB, who were treated with second-line TB therapy for 2 years and then followed for an additional 6 months. CT scans were read semiquantitatively by radiologists and were computationally evaluated using custom software to provide volumetric assessment of TB-associated abnormalities. CT scans at 6 months (but not 2 months) assessed by radiologist readers were predictive of outcomes, and changes in computed abnormal volumes were predictive of drug response at both time points. Quantitative changes in FDG uptake 2 months after starting treatment were associated with long-term outcomes. In this cohort, some radiologic markers were more sensitive than conventional sputum microbiology in distinguishing successful from unsuccessful treatment. These results support the potential of imaging scans as possible surrogate endpoints in clinical trials of new TB drug regimens. Larger cohorts confirming these results are needed. Copyright © 2014, American Association for the Advancement of Science.Science translational medicine 12/2014; 6(265):265ra166. DOI:10.1126/scitranslmed.3009501 · 14.41 Impact Factor