(18)F-氟脱氧葡萄糖正电子发射断层扫描在黑色素瘤患者中诊断准确性的系统评价。

Systematic review of the diagnostic accuracy of (18)F-fluorodeoxyglucose positron emission tomography in melanoma patients.

作者信息

Mijnhout G S, Hoekstra O S, van Tulder M W, Teule G J, Devillé W L

机构信息

Department of Nuclear Medicine, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.

出版信息

Cancer. 2001 Apr 15;91(8):1530-42.

PMID:11301402

Abstract

BACKGROUND

Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) is a rapidly developing new imaging technique in the diagnosis and staging of melanoma. The objective of the current study was to determine the diagnostic accuracy of FDG-PET in patients with melanoma.

METHODS

A systematic review and meta-analysis of clinical studies regarding FDG-PET and cutaneous melanoma was conducted. Studies were identified by a comprehensive search of the MEDLINE, EMBASE, and Current Contents databases, without any language restrictions. Eleven studies were selected. The methodologic quality of these studies was assessed independently by two reviewers. Levels of evidence and grades of recommendation were determined for each study. Six studies could be included in the statistical pooling. Sources of heterogeneity were studied by meta-regression of the diagnostic odds ratio (DOR). A summary receiver operating characteristic curve was calculated.

RESULTS

The pooled sensitivity and specificity of FDG-PET in the detection of melanoma metastases were 0.79 (95% confidence interval [95% CI], 0.66-0.93) and 0.86 (95% CI, 0.78-0.95), respectively. The pooled DOR of 33.1 (95% CI, 21.9-54.0) suggests a high diagnostic accuracy for PET. Subgroup analysis revealed that PET is more accurate for systemic staging (DOR of 36.4) than for regional staging (DOR of 19.5). When used for regional staging, PET performed better in patients with American Joint Committee on Cancer Stage III disease, compared with patients with Stage I and Stage II disease. However, the methodologic quality of the studies was limited. Major problems were verification, review, and selection bias.

CONCLUSIONS

Due to the poor methodologic quality of the available studies, to the authors' knowledge it is yet not possible to develop guidelines for the effective use of PET in patients with melanoma. Future accuracy studies should meet the methodologic criteria outlined in the current review.

摘要

背景

正电子发射断层扫描（PET）联合（18）F - 氟脱氧葡萄糖（FDG）是黑色素瘤诊断和分期中一种快速发展的新型成像技术。本研究的目的是确定FDG - PET对黑色素瘤患者的诊断准确性。

方法

对关于FDG - PET和皮肤黑色素瘤的临床研究进行系统评价和荟萃分析。通过全面检索MEDLINE、EMBASE和《现刊目次》数据库来识别研究，无语言限制。选择了11项研究。由两名评价者独立评估这些研究的方法学质量。确定每项研究的证据水平和推荐等级。六项研究可纳入统计合并分析。通过对诊断比值比（DOR）进行荟萃回归研究异质性来源。计算汇总的受试者工作特征曲线。

结果

FDG - PET检测黑色素瘤转移的汇总敏感性和特异性分别为0.79（95%置信区间[95%CI]，0.66 - 0.93）和0.86（95%CI，0.78 - 0.95）。汇总的DOR为33.1（95%CI，21.9 - 54.0）表明PET具有较高的诊断准确性。亚组分析显示，PET用于全身分期（DOR为36.4）比用于区域分期（DOR为19.5）更准确。当用于区域分期时，与I期和II期疾病患者相比，PET在美国癌症联合委员会III期疾病患者中表现更好。然而，这些研究的方法学质量有限。主要问题是验证、审查和选择偏倚。