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1.
Comparison of 5 Different PET Radiopharmaceuticals for the Detection of Recurrent Medullary Thyroid Carcinoma: A Network Meta-analysis.
Lee, SW, Shim, SR, Jeong, SY, Kim, SJ
Clinical nuclear medicine. 2020;(5):341-348
Abstract
PURPOSE The aim of this study is to investigate and compare the performance of different PET radiopharmaceuticals for the detection of recurrent medullary thyroid carcinoma (MTC) by performing a network meta-analysis (NMA) using direct comparison studies with 2 or more PET radiopharmaceuticals. METHODS PubMed and EMBASE were searched for the studies evaluating the performance of PET or PET/CT for the detection of recurrent MTC. The NMA was performed for different PET radiopharmaceuticals in both patient- and lesion-based analyses and with a threshold of serum calcitonin or carcinoembryonic antigen (CEA) levels and calcitonin doubling time. The consistency was evaluated by examining the agreement between direct and indirect treatment effects, and publication bias was assessed by funnel plot asymmetry tests. The surface under the cumulative ranking curve values were obtained to calculate the probability of each PET modality being the most effective diagnostic method. RESULTS A total of 306 patients from 14 direct comparison studies using 5 different PET radiopharmaceuticals (F-FDG, F-DOPA, Ga-somatostatin analogs, 3-O-methyl-6-[F]fluoro-DOPA, and C-methionine) for the detection of recurrent MTC was included. The detection rate of F-DOPA PET was significantly higher than that of FDG PET in both patient- and lesion-based analyses (patient-based analysis: odds ratio, 2.44; 95% confidence interval, 1.4-4.31; lesion-based analysis: odds ratio, 5.74; 95% confidence interval, 1.65-23.4). Among all PET radiopharmaceuticals, F-DOPA showed the highest surface under the cumulative ranking curve value in both patient- and lesion-based analyses regardless of serum calcitonin or CEA levels and calcitonin doubling time. CONCLUSIONS The results from this NMA indicate that F-DOPA PET clearly showed a best performance for the detection of recurrent MTC in both patient- and lesion-based analyses regardless of serum calcitonin or CEA levels and calcitonin doubling time.
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PSMA-targeted Radiotracers versus 18F Fluciclovine for the Detection of Prostate Cancer Biochemical Recurrence after Definitive Therapy: A Systematic Review and Meta-Analysis.
Tan, N, Oyoyo, U, Bavadian, N, Ferguson, N, Mukkamala, A, Calais, J, Davenport, MS
Radiology. 2020;(1):44-55
Abstract
Background National guidelines endorse fluorine 18 (18F) fluciclovine PET/CT for the detection of prostate cancer (PCa) in men with biochemically recurrent PCa. The comparative performance between fluciclovine and gallium 68 or 18F prostate-specific membrane antigen (PSMA) PET/CT, a newer examination, is unclear. Purpose To compare the detection of biochemical recurrence using fluciclovine versus PSMA-targeted radiotracers in patients with a prostate-specific antigen (PSA) level less than 2 ng/mL. Materials and Methods With use of the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy, or PRISMA-DTA, guidelines, a systematic review of PubMed and EMBASE databases between 2012 and 2019 was performed. Studies of fluciclovine PET/CT or PSMA PET/CT in biochemical recurrence were identified. PSA levels, clinical data, and reference standards were obtained when available. A random-effects model was applied to pooled estimates and 95% confidence intervals (CIs) around the prevalence of a positive examination, stratified according to PSA tier. Results Quantitative analysis included 482 patients (median age, 67 years; interquartile range, 67-67 years) in six fluciclovine studies and 3217 patients (median age, 68 years; interquartile range, 67-70 years) in 38 PSMA studies. Pooled detection rates for PSMA and fluciclovine were 45% (95% CI: 38%, 52%) and 37% (95% CI: 25%, 49%), respectively, for a PSA level less than 0.5 ng/mL (P = .46); 59% (95% CI: 52%, 66%) and 48% (95% CI: 34%, 61%) for a PSA level of 0.5-0.9 ng/mL (P = .19); and 80% (95% CI: 75%, 85%) and 62% (95% CI: 54%, 70%) for a PSA level of 1.0-1.9 ng/mL (P = .01). A reference standard was positive in 703 of 735 patients (96%) in the PSMA cohort and 247of 256 (97%) in the fluciclovine cohort. Conclusion Patient-level detection rates for biochemically recurrent prostate cancer were greater for prostate-specific membrane antigen-targeted radiotracers than fluciclovine for prostate specific antigen levels of 1.0-1.9 ng/mL. © RSNA, 2020 Online supplemental material is available for this article.
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Soy and isoflavones consumption and breast cancer survival and recurrence: a systematic review and meta-analysis.
Qiu, S, Jiang, C
European journal of nutrition. 2019;(8):3079-3090
Abstract
BACKGROUND Some studies have investigated the association between soy and isoflavones consumption and breast cancer survival, but the results are far from conclusive. Accordingly, we performed a systematic review and meta-analysis to explore this issue. METHODS We performed a comprehensive search of Web of Science, PubMed, and Embase from inception to January 2018. The summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a random effects model. RESULTS A total of 12 articles were included, which reported overall survival (OS), breast cancer specific survival (BCSS), and recurrence in 5770, 2386, and 1500 cases, respectively, among 37,275 women with breast cancer. The summary HR (95% CI) for the association (highest vs. lowest) of pre-diagnosis soy and isoflavones consumption with OS and BCSS was 0.84 (0.71-0.98) and 0.89 (0.74-1.07), respectively. Stratified analyses suggested that the reduced OS was more easily detected in studies that focused on post-menopausal patients. No significant association was found between post-diagnosis soy and isoflavones consumption with OS and BCSS, with summary HRs (95% CIs) of 0.80 (0.62-1.04) and 0.83 (0.64-1.07), respectively. Pre- and post-diagnosis soy isoflavones consumption were associated with reduced risk of recurrence. CONCLUSION This study provides limited evidence that pre-diagnosis soy and isoflavones intake is associated with a small reduction in post-menopausal breast cancer OS.
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Diagnostic Accuracy of Amino Acid and FDG-PET in Differentiating Brain Metastasis Recurrence from Radionecrosis after Radiotherapy: A Systematic Review and Meta-Analysis.
Li, H, Deng, L, Bai, HX, Sun, J, Cao, Y, Tao, Y, States, LJ, Farwell, MD, Zhang, P, Xiao, B, et al
AJNR. American journal of neuroradiology. 2018;(2):280-288
Abstract
BACKGROUND Current studies that analyze the usefulness of amino acid and FDG-PET in distinguishing brain metastasis recurrence and radionecrosis after radiation therapy are limited by small cohort size. PURPOSE Our aim was to assess the diagnostic accuracy of amino acid and FDG-PET in differentiating brain metastasis recurrence from radionecrosis after radiation therapy. DATA SOURCES Studies were retrieved from PubMed, Embase, and the Cochrane Library. STUDY SELECTION Fifteen studies were included from the literature. Each study used PET to differentiate radiation necrosis from tumor recurrence in contrast-enhancing lesions on follow-up brain MR imaging after treating brain metastasis with radiation therapy. DATA ANALYSIS Data were analyzed with a bivariate random-effects model. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were pooled, and a summary receiver operating characteristic curve was fit to the data. DATA SYNTHESIS The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of PET were 0.85, 0.88, 7.0, 0.17, and 40, respectively. The area under the receiver operating characteristic curve was 0.93. On subgroup analysis of different tracers, amino acid and FDG-PET had similar diagnostic accuracy. Meta-regression analysis demonstrated that the method of quantification based on patient, lesion, or PET scan (based on lesion versus not, P = .07) contributed to the heterogeneity. LIMITATIONS Our study was limited by small sample size, and 60% of the included studies were of retrospective design. CONCLUSIONS Amino acid and FDG-PET had good diagnostic accuracy in differentiating brain metastasis recurrence from radionecrosis after radiation therapy.
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Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: A systematic review and meta-analysis.
Park, DA, Yun, JE, Kim, SW, Lee, SH
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2017;(6):994-1002
Abstract
AIM: This study aimed to evaluate the surgical safety and clinical effectiveness of RH versus LH and laparotomy for cervical cancer. METHODS We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library through May 2015, and checked references of relevant studies. We selected the comparative studies reported the surgical safety (overall; peri-operative; and post-operative complications; death within 30 days; and specific morbidities), and clinical effectiveness (survival; recurrence; length of stay [LOS]; estimated blood loss [EBL]; operative time [OT]) and patient-reported outcomes. RESULTS Fifteen studies comparing RH with OH and 11 comparing RH with LH were identified. No significant differences were found in survival outcomes. The LOS was shorter and transfusion rate was lower with RH compared to OH or LH. EBL was significantly reduced with RH compared to OH. Compared to OH, overall complications, urinary infection, wound infection, and fever were significantly less frequent with RH. The overall, peri-operative, and post-operative complications were similar in other comparisons. Several patient-reported outcomes were improved with RH, though each outcome was reported in only one study. CONCLUSIONS RH appears to have a positive effect in reducing overall complications, individual adverse events including wound infection, fever, urinary tract infection, transfusion, LOS, EBL, and time to diet than OH for cervical cancer patients. Compared to LH, the current evidence is not enough to clearly determine its clinical safety and effectiveness. Further rigorous prospective studies with long-term follow-up that overcome the many limitations of the current evidence are needed.
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Diagnostic efficacy of 18F-FDG-PET or PET/CT in breast cancer with suspected recurrence: a systematic review and meta-analysis.
Xiao, Y, Wang, L, Jiang, X, She, W, He, L, Hu, G
Nuclear medicine communications. 2016;(11):1180-8
Abstract
OBJECTIVES The early detection of suspiciously recurrent breast cancer is of significant importance. The aim of the present meta-analysis was to evaluate the overall diagnostic accuracy of fluorine-18 fluorodeoxyglucose (F-FDG)-PET or PET/computed tomography (CT) for the detection of relapse in suspected recurrent breast cancer. MATERIALS AND METHODS Medline, Embase, Web of Science, and Cochrane databases were searched for articles on suspiciously recurrent breast cancer and F-FDG-PET or PET/CT up to 10 January 2016. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC) were calculated. A meta-regression analysis was carried out to explore potential sources of heterogeneity. RESULTS A total of 26 studies with 1752 patients with suspiciously recurrent breast cancer were included for the analysis; among these, 56.8% because of elevation of tumor markers, in 33.9%, there was suspicion on conventional imaging modalities, and in 9.4%, suggestive clinical symptoms or physical examinations were found. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG-PET or PET/CT were 0.90 [95% confidence interval (CI), 0.88-0.90], 0.81 (95% CI, 0.78-0.84), 4.64 (95% CI, 3.50-6.14), 0.12 (95% CI, 0.08-0.16), and 46.52 (95% CI, 29.44-73.51), respectively. In addition, the overall AUC of F-FDG-PET or PET/CT was 0.9358. Meta-regression analysis showed that type of imaging modality (PET over PET/CT) might be a potential source of heterogeneity (P=0.0799). Furthermore, a subgroup analysis indicated that PET/CT appeared to harbor more specificity in the diagnosis of recurrent breast cancer (0.823 vs. 0.796, P=0.035). The increased AUC suggested increased accuracy of PET/CT over PET (0.9477 vs. 0.9111). CONCLUSION F-FDG-PET, and in particular F-FDG-PET/CT, seemed to be a more valuable supplement to current surveillance techniques to detect relapse in suspected recurrent breast cancer patients.
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Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative (131) I whole-body scan results: A meta-analysis.
Caetano, R, Bastos, CR, de Oliveira, IA, da Silva, RM, Fortes, CP, Pepe, VL, Reis, LG, Braga, JU
Head & neck. 2016;(2):316-27
Abstract
BACKGROUND The purpose of this review was to present a meta-analysis aimed to evaluate the accuracy of positron emission tomography (PET) and PET-CT for detecting recurrence of differentiated thyroid carcinoma (DTC) not identified by (131) I whole-body scintigraphy. METHODS MEDLINE, EMBASE, LILACS, and Cochrane databases were searched for studies published between January 1985 and March 2012. Systematic methods were used to select and evaluate the quality of studies. Pooled sensitivity and specificity for conventional PET and PET-CT was estimated using random effects model. RESULTS Twenty studies were included in the systematic review; the data of 18 studies were used in the meta-analysis. The combined sensitivity and specificity for conventional PET were both found to be 84%; for PET-CT, they were 93% and 81%, respectively. The overall accuracies were 91% and 93%, respectively. CONCLUSION (18) Fluorodeoxyglucose (FDG)-PET and PET-CT are highly accurate diagnostics tools for DTC recurrence in patients who present a negative whole-body scintigraphy and could impact the clinical and therapeutic management of DTC.
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Performance of Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Using Fluorine-18-Fluorodeoxyglucose for the Diagnosis, Staging, and Recurrence Assessment of Bone Sarcoma: A Systematic Review and Meta-Analysis.
Liu, F, Zhang, Q, Zhu, D, Liu, F, Li, Z, Li, J, Wang, B, Zhou, D, Dong, J
Medicine. 2015;(36):e1462
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Abstract
To investigate the performance of fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the diagnosis, staging, restaging, and recurrence surveillance of bone sarcoma by systematically reviewing and meta-analyzing the published literature.To retrieve eligible studies, we searched the MEDLINE, Embase, and the Cochrane Central library databases using combinations of following Keywords: "positron emission tomography" or "PET," and "bone tumor" or "bone sarcoma" or "sarcoma." Bibliographies from relevant articles were also screened manually. Data were extracted and the pooled sensitivity, specificity, and diagnostic odds ratio (DOR), on an examination-based or lesion-based level, were calculated to appraise the diagnostic accuracy of F-FDG PET and PET/CT. All statistical analyses were performed using Meta-Disc 1.4.Forty-two trials were eligible. The pooled sensitivity and specificity of PET/CT to differentiate primary bone sarcomas from benign lesions were 96% (95% confidence interval [CI], 93-98) and 79% (95% CI, 63-90), respectively. For detecting recurrence, the pooled results on an examination-based level were sensitivity 92% (95% CI, 85-97), specificity 93% (95% CI, 88-96), positive likelihood ratio (PLR) 10.26 (95% CI, 5.99-17.60), and negative likelihood ratio (NLR) 0.11 (95% CI, 0.05-0.22). For detecting distant metastasis, the pooled results on a lesion-based level were sensitivity 90% (95% CI, 86-93), specificity 85% (95% CI, 81-87), PLR 5.16 (95% CI, 2.37-11.25), and NLR 0.15 (95% CI, 0.11-0.20). The accuracies of PET/CT for detecting local recurrence, lung metastasis, and bone metastasis were satisfactory. Pooled outcome estimates of F-FDG PET were less complete compared with those of PET/CT.F-FDG PET and PET/CT showed a high sensitivity for diagnosing primary bone sarcoma. Moreover, PET/CT demonstrated excellent accuracy for the staging, restaging, and recurrence surveillance of bone sarcoma. However, to avoid misdiagnosis, pathological examination or long-term follow-up should be carried out for F-FDG-avid lesions in patients with suspected bone sarcoma.
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Everolimus in de novo liver transplant recipients: a systematic review.
Tang, CY, Shen, A, Wei, XF, Li, QD, Liu, R, Deng, HJ, Wu, YZ, Wu, ZJ
Hepatobiliary & pancreatic diseases international : HBPD INT. 2015;(5):461-9
Abstract
BACKGROUND Everolimus has no nephrotoxicity and is used to treat patients with post-liver transplant chronic renal insufficiency. The present systematic review was to evaluate the efficacy and safety of everolimus in de novo liver transplant patients. DATA SOURCES Randomized controlled trials comparing everolimus for de novo liver transplant in PubMed, the Cochrane Library, and ScienceDirect published up to March 31, 2014 were searched by two independent reviewers. Mean differences and 95% confidence interval (95% CI) for renal function, relative risk (RR) and 95% CI for treated biopsy-proven acute rejection (tBPAR), graft loss, death, neoplasms/tumor recurrence, and adverse events were collected. Meta-analyses were performed with RevMan version 5.10. RESULTS A total of four randomized controlled trials covering 1119 cases were included. The meta-analyses revealed that compared with standard exposure of calcineurin inhibitors (CNIs), everolimus combined with reduced CNIs improved creatinine clearance (calculated with the Cockcroft-Gault formula) by 5.13 mL/min at one year (95% CI: 0.42-9.84; P=0.03), and decreased tBPAR (RR: 0.56; 95% CI: 0.35-0.90; P=0.02). Everolimus initiation with CNIs elimination improved glomerular filtration rate (GFR, measured with the modification of diet in renal disease formula) of 10.42 mL/min/1.73 m2 (95% CI: 3.44-17.41; P<0.01) one year after treatment, but increased tBPAR (RR: 1.71; 95% CI: 1.15-2.53; P<0.01). Everolimus decreased the risk of neoplasms/tumor recurrence after liver transplant (RR: 0.60; 95% CI: 0.34-1.03; P=0.06), but was associated with greater risk of adverse events which resulted in drug discontinuation (RR: 1.98; 95% CI: 1.49-2.64; P<0.01). CONCLUSIONS Early introduction of everolimus combined with low-dose or no CNI in de novo liver transplant significantly improves renal function one year post treatment. Everolimus combined with low-dose CNI decreases the risk of tBPAR one year after liver transplant, but everolimus administered without CNIs increases tBPAR.
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Diagnostic Value of (18)F-FDG PET/CT in Detecting Local Recurrent Colorectal Cancer: A Pooled Analysis of 26 Individual Studies.
Yu, T, Meng, N, Chi, D, Zhao, Y, Wang, K, Luo, Y
Cell biochemistry and biophysics. 2015;(2):443-51
Abstract
Fluorine 18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) has emerged as a new modality for colorectal cancer (CRC) patients. The aim of this meta-analysis was to assess the diagnostic value of (18)F-FDG PET/CT in detecting local recurrence in patients with CRC. We searched PubMed, Medline, Embase, and ISI databases to collect articles in English that evaluated the diagnostic value of (18)F-FDG PET/CT in patients with CRC. Two reviewers independently assessed the methodological quality of each study using the quality assessment of diagnostic accuracy studies tool. The data were analyzed using Meta-Disc (Version 1.4) and Stata (Version 12.0) software. We estimated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC). A total of 26 studies were included. When all the eligible studies included, the pooled sensitivity and specificity for (18)F-FDG PET/CT in detecting CRC were 0.94 (95 % confidence interval [CI] 0.92-0.96) and 0.94 (95 % CI 0.93-0.95), respectively. The pooled PLR and NLR were 14.39 (95 % CI 7.37-28.09) and 0.08 (95 % CI 0.06-0.12), respectively. The DOR was 208.67 (95 % CI 109.56-397.44) and the area under the SROC curve was 0.9776. The overall diagnostic accuracy (Q* index) was 0.9329. (18)F-FDG PET/CT has good diagnostic performance in detecting local recurrence in patients with CRC. Further larger prospective studies are needed to establish its value for detecting local recurrence of CRC cancer patients.