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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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A meta-analysis comparing 18F-FLT PET with 18F-FDG PET for assessment of brain tumor recurrence.
Li, Z, Yu, Y, Zhang, H, Xu, G, Chen, L
Nuclear medicine communications. 2015;(7):695-701
Abstract
OBJECTIVE The purpose of this systematic meta-analysis was to evaluate the diagnostic accuracy of 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET for the assessment of glioma recurrence and compare it with that of (18)F-fluorodeoxyglucose ((18)F-FDG) PET. METHODS The authors electronically and manually searched for studies from 1948 to 2014 that evaluated the diagnostic accuracy of (18)F-FDG or (18)F-FLT PET for glioma recurrence. The primary results of sensitivity, specificity, and diagnostic odds ratio (DOR) were summarized using the random-effects model. Summary receiver operating characteristic (ROC) curves and its area under the curve (AUC were used to summarize the overall diagnostic accuracy. Statistical analysis was performed with the software STATA (version 11.0). RESULTS Twenty-four studies that included a total of 799 patients were included in the meta-analysis. The pooled sensitivity, specificity, DOR, and summary ROC AUC for the overall diagnostic accuracy of (18)F-FDG PET were 0.78 (95% CI 0.69-0.85), 0.77 (95% CI 0.66-0.85), 12 (95% CI 6-22), and 0.84 (95% CI 0.81-0.87), respectively. The pooled sensitivity, specificity, DOR, and summary ROC AUC for the overall diagnostic accuracy of (18)F-FLT PET were 0.82 (95% CI 0.51-0.95), 0.76 (95% CI 0.50-0.91), 15 (95% CI 4-56), and 0.85 (95% CI 0.81-0.88), respectively. Metaregression analysis showed that year of publication, male proportion, average age, and blinding review did not affect the test performance statistically significantly (all P > 0.05). CONCLUSION This meta-analysis indicates that PET by using (18)F-FLT has a moderately better overall accuracy for diagnosing glioma recurrence compared with that by using (18)F-FDG. Video abstract: http://links.lww.com/NMC/A41.