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Assessing the role of 18F-FDG PET and 18F-FDG PET/CT in the diagnosis of soft tissue musculoskeletal malignancies: a systematic review and meta-analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Twelve years ago a meta-analysis evaluated the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in assessing musculoskeletal soft tissue lesions (MsSTL). Currently, PET/CT has substituted PET imaging; however, there has not been any published meta-analysis on the use of PET/CT or a comparison of PET/CT with PET in the diagnosis of MsSTL. Therefore, we conducted a meta-analysis to identify the current diagnostic performance of 18F-FDG PET/CT and determine if there is added value when compared to PET.

Methods

A systematic review of English articles was conducted, and MEDLINE PubMed, the Cochrane Library, and Embase were searched from 1996 to March 2015. Studies exploring the diagnostic accuracy of 18F-FDG PET/CT (or dedicated PET) compared to histopathology in patients with MsSTL undergoing investigation for malignancy were included.

Results

Our meta-analysis included 14 articles composed of 755 patients with 757 soft tissue lesions. There were 451 (60 %) malignant tumors and 306 benign lesions. The 18F-FDG PET/CT (and dedicated PET) mean sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for diagnosing MsSTL were 0.96 (0.90, 1.00), 0.77 (0.67, 0.86), 0.88 (0.85, 0.91), 0.86 (0.78, 0.94), and 0.91 (0.83, 0.99), respectively. The posterior mean (95 % highest posterior density interval) for the AUC was 0.92 (0.88, 0.96). PET/CT had higher specificity, accuracy, and positive predictive value when compared to a dedicated PET (0.85, 0.89, and 0.91 vs 0.71, 0.85, and 0.82, respectively).

Conclusion

18F-FDG PET/CT and dedicated PET are both highly accurate in the diagnosis of MsSTL. PET/CT is more accurate and specific and has a higher positive predictive value than PET.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, FCT 16.6005, Unit 1483, Houston, TX, 77030, USA

    Elba C. Etchebehere & Homer A. Macapinlac

  2. Department of Nuclear Medicine, Sirio Libanes Hospital, São Paulo, Brazil

    Elba C. Etchebehere

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Brian P. Hobbs & Denái R. Milton

  4. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Osama Malawi

  5. Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shreyaskumar Patel & Robert S. Benjamin

Authors
  1. Elba C. Etchebehere
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Correspondence to Elba C. Etchebehere.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent does not apply as this is a review manuscript.

Funding

This study was funded by the James E. Anderson Distinguished Professorship Endowment, by the Cancer center support grant: NIH/NCI P30CA016672, by the MN&D Group-BRAZIL, by the University of Campinas and by the Fundação de Amparo à Pesquisa da Universidade de São Paulo, BRAZIL (FAPESP 2014/03317-8).

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(SUPPLEMENT). Image acquisition characteristics. (DOCX 32 kb)

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Etchebehere, E.C., Hobbs, B.P., Milton, D.R. et al. Assessing the role of 18F-FDG PET and 18F-FDG PET/CT in the diagnosis of soft tissue musculoskeletal malignancies: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 43, 860–870 (2016). https://doi.org/10.1007/s00259-015-3242-z

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  • DOI: https://doi.org/10.1007/s00259-015-3242-z

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