Performance of Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Using Fluorine-18-Fluorodeoxyglucose for the Diagnosis, Staging, and Recurrence Assessment of Bone Sarcoma

Abstract

To investigate the performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the diagnosis, staging, restaging, and recurrence surveillance of bone sarcoma by systematically reviewing and meta-analyzing the published literature.To retrieve eligible studies, we searched the MEDLINE, Embase, and the Cochrane Central library databases using combinations of following Keywords: “positron emission tomography” or “PET,” and “bone tumor” or “bone sarcoma” or “sarcoma.” Bibliographies from relevant articles were also screened manually. Data were extracted and the pooled sensitivity, specificity, and diagnostic odds ratio (DOR), on an examination-based or lesion-based level, were calculated to appraise the diagnostic accuracy of 18F-FDG PET and PET/CT. All statistical analyses were performed using Meta-Disc 1.4.Forty-two trials were eligible. The pooled sensitivity and specificity of PET/CT to differentiate primary bone sarcomas from benign lesions were 96% (95% confidence interval [CI], 93–98) and 79% (95% CI, 63–90), respectively. For detecting recurrence, the pooled results on an examination-based level were sensitivity 92% (95% CI, 85–97), specificity 93% (95% CI, 88–96), positive likelihood ratio (PLR) 10.26 (95% CI, 5.99–17.60), and negative likelihood ratio (NLR) 0.11 (95% CI, 0.05–0.22). For detecting distant metastasis, the pooled results on a lesion-based level were sensitivity 90% (95% CI, 86–93), specificity 85% (95% CI, 81–87), PLR 5.16 (95% CI, 2.37–11.25), and NLR 0.15 (95% CI, 0.11–0.20). The accuracies of PET/CT for detecting local recurrence, lung metastasis, and bone metastasis were satisfactory. Pooled outcome estimates of 18F-FDG PET were less complete compared with those of PET/CT.18F-FDG PET and PET/CT showed a high sensitivity for diagnosing primary bone sarcoma. Moreover, PET/CT demonstrated excellent accuracy for the staging, restaging, and recurrence surveillance of bone sarcoma. However, to avoid misdiagnosis, pathological examination or long-term follow-up should be carried out for 18F-FDG-avid lesions in patients with suspected bone sarcoma.

Effectiveness of 18F-FDG PET/CT in the diagnosis, staging and recurrence monitoring of Ewing sarcoma family of tumors

“…Results of the diagnostic accuracy of 18 F-FDG PET and PET/CT in ESFT remain inconclusive. One previous study [37] tried to further clarify this issue, but none of the included studies specifically aimed at ESFT and did not statistically analyze the retrieved data. To the best of our knowledge, there is no meta-analysis comprehensively evaluating the performance of 18 F-FDG PET and PET/CT in the diagnosis, staging and recurrence monitoring of ESFT.…”

Evidence-Based PET for Cutaneous, Musculoskeletal and Unknown Primary Tumours

“…This is important for the follow-up and the evaluation of the therapy response [11]. About 18 F-FDG PET/CT in sarcomas, according to evidencebased data, the values vary between 86 and 96% for sensitivity and from 80 to 96% for specificity [12][13][14][15]. In particular, this hybrid imaging method is very useful for detecting distant metastases, as osseous and lung metastases [12,15].…”

Current update on the diagnosis and management of head and neck hard tissue sarcomas

“…Furthermore, OS and CS usually cause widening of the periodontal ligament, whereas no space is seen in cementoblastomas . In a meta‐analysis, positron emission tomography (PET) with CT showed excellent accuracy for staging, recurrence and surveillance of OS, and it has a role in assessing treatment response to following chemotherapy . However, PET is unreliable in distinguishing benign from malignant chondrogenic lesions, metastatic disease or tumour recurrence.…”