A Bayesian approach for diagnostic accuracy of malignant peripheral nerve sheath tumors: a systematic review and meta-analysis

Abstract

Background Malignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling errors and biopsies or resections are cumbersome and possibly damaging in benign peripheral nerve sheath tumor (BPNST). This study aimed to systematically review and quantify the diagnostic accuracy of noninvasive tests for distinguishing MPNST from BPNST. Methods Studies on accuracy of MRI, FDG-PET (fluorodeoxyglucose positron emission tomography), and liquid biopsies were identified in PubMed and Embase from 2000 to 2019. Pooled accuracies were calculated using Bayesian bivariate meta-analyses. Individual level-patient data were analyzed for ideal maximum standardized uptake value (SUVmax) threshold on FDG-PET. Results Forty-three studies were selected for qualitative synthesis including data on 1875 patients and 2939 lesions. Thirty-five studies were included for meta-analyses. For MRI, the absence of target sign showed highest sensitivity (0.99, 95% CI: 0.94-1.00); ill-defined margins (0.94, 95% CI: 0.88-0.98); and perilesional edema (0.95, 95% CI: 0.83-1.00) showed highest specificity. For FDG-PET, SUVmax and tumor-to-liver ratio show similar accuracy; sensitivity 0.94, 95% CI: 0.91-0.97 and 0.93, 95% CI: 0.87-0.97, respectively, specificity 0.81, 95% CI: 0.76-0.87 and 0.79, 95% CI: 0.70-0.86, respectively. SUVmax ≥3.5 yielded the best accuracy with a sensitivity of 0.99 (95% CI: 0.93-1.00) and specificity of 0.75 (95% CI: 0.56-0.90). Conclusions Biopsies may be omitted in the presence of a target sign and the absence of ill-defined margins or perilesional edema. Because of diverse radiological characteristics of MPNST, biopsies may still commonly be required. In neurofibromatosis type 1, FDG-PET scans may further reduce biopsies. Ideal SUVmax threshold is ≥3.5.

Differentiation between glioma recurrence and treatment effects using amide proton transfer imaging: A mini-Bayesian bivariate meta-analysis

“…Bayesian inference adds a small amount of informative priors that can stabilize the analysis without overwhelming data ( 24 ), as opposed to the frequentist methods that express the initial uncertainty with a prior distribution. Bayesian bivariate meta-analyses have advantages in estimating the heterogeneity among studies and pooled effect, especially when the number of studies included is small ( 25 ).…”

Diagnostic value of 18F-FDG PET-CT in detecting malignant peripheral nerve sheath tumors among adult and pediatric neurofibromatosis type 1 patients

“…A threshold of 3.5 for SUVmax has often been proposed as the ideal threshold [21][22][23]. A recent meta-analysis pooled individual level patient data from 11 different study populations and found a threshold of 3.5 provided the highest sensitivity (0.99) and acceptable specificity (0.75) [24]. Arguments against using this threshold often consisted of the low specificity it offered.…”

“…Altogether, the results from these studies will provide a framework that may enable optimal diagnostic algorithms to be formulated. This study only assessed the diagnostic accuracy of 18 F-FDG PET-CT. A recently published metaanalysis reported that although conventional MRI yields varying degrees of accuracy, some studies have shown high accuracies in functional MRI [24]. Though further research is required on this modality, reducing the need for 18 F-FDG PET-CT may diminish radiation exposure that accumulates due to numerous follow-up scans necessary in NF1 patients prone to tumorigenesis.…”

“…There is large variation in current literature regarding this matter, part of which might be caused by variation among scanners and scanning protocols [17][18][19][20]. Suggested optimal threshold values of semi-quantitative parameters vary greatly, but the SUVmax threshold of ≥ 3.5 is commonly cited [21][22][23][24]. However, its value has been doubted since it may provide high false positive rates [22].…”

Recommendations of the Polish Sarcoma Group on diagnostic-therapeutic procedures and control in patients with type 1 neurofibromatosis (NF1) and the associated malignant neoplasm of peripheral nerve sheaths

“…Using the quotient of the SUV index tissue/liver (T/L) may eliminate the difference between scanners, but the optimal value of the T/L index has not been defined. The use of repeated PET-CT with a delay increases the diagnostic value but also in parallel the costs and exposes the patient to ionizing radiation [92,93].…”