Journal of Gynecologic Oncology

Korean Society of Gynecologic Oncology (대한부인종양학회)
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Performance of pre-treatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis

  • Han, Sangwon (Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group) ;
  • Woo, Sungmin (Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group) ;
  • Suh, Chong Hyun (Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group) ;
  • Lee, Jong Jin (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.04.01
  • Accepted : 2018.08.20
  • Published : 2018.11.10
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Abstract

Objective: We describe a systematic review and meta-analysis of the performance of ${18}F$-fluorodeoxyglucose ($^{18}F-FDG$) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. Methods: MEDLINE and Embase were searched for diagnostic accuracy studies that used $^{18}F-FDG$ PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. Results: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61-0.81) and 0.93 (95% CI=0.85-0.97), respectively. There was considerable heterogeneity in sensitivity ($I^2=97.57%$) and specificity ($I^2=96.74%$). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67-0.87 and 0.96; 95% CI=0.92-0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46-0.77 and 0.84; 95% CI=0.69-0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90-0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24-1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94-1.00) than those with a greater prevalence (0.89; 95% CI=0.80-0.97). Conclusion: Pre-treatment $^{18}F-FDG$ PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.

Keywords

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