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http://dx.doi.org/10.3802/jgo.2018.29.e98

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)
Publication Information
Journal of Gynecologic Oncology / v.29, no.6, 2018 , pp. 98.1-98.13 More about this Journal
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
PET Scan; Ovarian Neoplasms; Neoplasm Metastasis; Sensitivity and Specificity; Meta-Analysis;
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