J Gynecol Oncol.  2018 Nov;29(6):e98. 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 S
• Woo S
• Suh CH
• Lee JJ

• KMID: 2431243
• DOI: http://doi.org/10.3802/jgo.2018.29.e98

Abstract

OBJECTIVE
We describe a systematic review and meta-analysis of the performance of 18F-fluorodeoxyglucose (18F-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 18F-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 (I2=97.57%) and specificity (I2=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 18F-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.

Keyword

PET Scan; Ovarian Neoplasms; Neoplasm Metastasis; Sensitivity and Specificity; Meta-Analysis

MeSH Terms

Electrons*
Fluorodeoxyglucose F18
Humans
Laparoscopy
Laparotomy
Neoplasm Metastasis*
Ovarian Neoplasms*
Population Characteristics
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Prevalence
ROC Curve
Sensitivity and Specificity
Fluorodeoxyglucose F18