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[18F]-FDG PET in anal canal cancer: 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

To provide comprehensive data on the diagnostic and prognostic value of [18F]-FDG PET (PET) in anal canal cancer patients.

Methods

This study was designed following the PRISMA-DTA guidelines. For the meta-analysis, published original articles (until December 2022) that met the following criteria were included: Evaluated PET for locoregional and/or distant disease detection in patients with histopathology-proven anal canal cancer; Compared PET with a valid reference standard; Provided crude data to calculate meta-analytic estimates. Diagnostic measurements from subgroups were calculated in evaluating primary tumour detection, T stage, lymph node and distant metastases. Articles providing prognostic information on PET were also reported as a systematic review. For pooled meta-analytic calculations, the hierarchical method was used. The bivariate model was conducted to find the summary estimates. Analyses were performed using STATA 16.

Results

After the screening, 28 studies were eligible to enter the meta-analytic calculations, and data from 15 were reported descriptively. For distinguishing T3/T4 from other T-stages, PET had pooled sensitivity and specificity of 91%(95%CI:72%-97%) and 96%(95%CI:88%-98%), respectively. The sensitivity and specificity for detecting metastatic (regional and/or distant) disease were 100% (95%CI:82%-100%) and 95% (95%CI:90%-98%), respectively. For therapy response assessment, the sensitivity and specificity of PET were 96%(95%CI:78%-99%) and 86%(95%CI:75%-93%), respectively. Higher pre-treatment total metabolic tumour volume was predictive of poorer survival. Conversely, for those achieving complete metabolic response, the 2-year PFS was 94%(95%CI:91%-97%) versus 51%(95%CI:42%-59%) for others (p-value < 0.001).

Conclusion

PET may be a useful tool for anal canal cancer therapy planning and provides valuable prognostic information.

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Data availability

The detailed data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Notes

  1. [18F]-FDG PET value in N staging was reviewed in detail in the supplementary materials.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada

    Seyed Ali Mirshahvalad, Vanessa Murad, Andres Kohan, Claudia Ortega, Patrick Veit-Haibach & Ur Metser

  2. Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada

    Seyed Ali Mirshahvalad, Vanessa Murad, Andres Kohan, Claudia Ortega, Patrick Veit-Haibach & Ur Metser

  3. Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, ON, M5T 1P5, Canada

    Aruz Mesci

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Contributions

The idea proposed by [Ur Metser]. All authors contributed to the study conception and design. Material preparation and data collection were done by [Seyed Ali Mirshahvalad and Vanessa Murad]. Formal analyses were performed by [Seyed Ali Mirshahvalad]. The first draft of the manuscript was written by [Seyed Ali Mirshahvalad, Aruz Mesci, Vanessa Murad and Ur Metser] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ur Metser.

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Competing interests

Patrick Veit-Haibach:

IIS grants: Bayer Switzerland, Roche Pharmaceuticals, Siemens Healthineers, GE Healthcare, Point Biopharma

Speaker fees and travel support: Siemens Healthineers, GE Healthcare

Speaker fees: Ontario Association of Radiologists

Speaker fees: JCA PET/CT course

Springer Nature: Editor fee

Reviewer compensation: Wellcome Trust

German Cancer Center: Strategic panel advisory compensation and travel support

Ur Metser:

Consulting fees from POINT Biopharm

Chair, Ontario PET Steering Committee and Ontario Health-Cancer Care Ontario

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Mirshahvalad, S.A., Mesci, A., Murad, V. et al. [18F]-FDG PET in anal canal cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 51, 258–277 (2023). https://doi.org/10.1007/s00259-023-06393-z

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