18F-FDG PET在软组织肉瘤诊断及分级中的应用：一项荟萃分析

18F-FDG PET for the diagnosis and grading of soft-tissue sarcoma: a meta-analysis.

作者信息

Ioannidis John P A, Lau Joseph

机构信息

Tufts-New England Medical Center Evidence-Based Practice Center, Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.

出版信息

J Nucl Med. 2003 May;44(5):717-24.

PMID:12732672

Abstract

UNLABELLED

PET using (18)F-FDG is increasingly used for the diagnosis and grading of tumors. Several studies have been performed that evaluate the diagnostic and grading performance of (18)F-FDG PET for soft-tissue sarcoma, but each study has had a limited sample size. Therefore, we undertook a comprehensive meta-analysis of the evidence.

METHODS

Relevant studies were identified from MEDLINE and EMBASE. Diagnostic and grading performance were evaluated for qualitative visualization; standard uptake value (SUV, cutoffs of 2.0 and 3.0); and metabolic rate of glucose (MRG, cutoff of 6.0 micro mol/100 g/min). Quantitative data synthesis included independent weighting of sensitivity and specificity, construction of summary receiver operating characteristic curves, and pooled analyses.

RESULTS

The meta-analysis included 15 studies with 441 soft-tissue lesions (227 malignant, 214 benign). For diagnosis of malignant versus benign lesions, typical pairs of sensitivity and specificity estimates from the summary receiver operating characteristic curves were 92% and 73% for qualitative visualization; 87% and 79% for SUV 2.0; 70% and 87% for SUV 3.0; and 74% and 73% for MRG 6.0. Diagnostic performance was similar for primary and recurrent lesions. By qualitative interpretation, (18)F-FDG was positive in all intermediate/high-grade tumors (95% confidence interval [CI], 97.3%-100%), 74.4% (95% CI, 58.6%-85.9%) of low-grade tumors, and 39.3% (95% CI, 29.1%-50.3%) of benign lesions (including 11 of 12 inflammatory lesions). Using an SUV cutoff of 2.0, respective rates were 89.4% (95% CI, 79.4%-95.6%), 33.1% (95% CI, 15.6%-55.3%), and 19.1% (95% CI, 10.6%-30.5%). Limited data on comparisons with MRI and CT showed no differences against (18)F-FDG PET in diagnosing recurrent and metastatic disease.

CONCLUSION

(18)F-FDG PET has very good discriminating ability in the evaluation of both primary and recurrent soft-tissue lesions. (18)F-FDG PET may be helpful in tumor grading but offers inadequate discrimination between low-grade tumors and benign lesions.

摘要

未标注

使用（18）F-FDG的PET越来越多地用于肿瘤的诊断和分级。已经进行了几项研究来评估（18）F-FDG PET对软组织肉瘤的诊断和分级性能，但每项研究的样本量都有限。因此，我们对现有证据进行了全面的荟萃分析。

方法

从MEDLINE和EMBASE中检索相关研究。对定性可视化、标准摄取值（SUV，截断值为2.0和3.0）以及葡萄糖代谢率（MRG，截断值为6.0微摩尔/100克/分钟）的诊断和分级性能进行评估。定量数据合成包括敏感性和特异性的独立加权、汇总受试者工作特征曲线的构建以及合并分析。

结果

荟萃分析纳入了15项研究，共441个软组织病变（227个恶性，214个良性）。对于恶性与良性病变的诊断，汇总受试者工作特征曲线得出的典型敏感性和特异性估计值分别为：定性可视化时为92%和73%；SUV为2.0时为87%和79%；SUV为3.0时为70%和87%；MRG为6.0时为74%和73%。原发性和复发性病变的诊断性能相似。通过定性解释，（18）F-FDG在所有中/高级别肿瘤中均为阳性（95%置信区间[CI]，97.3%-100%），在低级别肿瘤中为74.4%（95%CI，58.6%-85.9%），在良性病变中为39.3%（95%CI，29.1%-50.3%）（包括12个炎症性病变中的11个）。使用SUV截断值2.0时，相应的比例分别为89.4%（95%CI，79.4%-95.6%）、33.1%（95%CI，15.6%-55.3%）和19.1%（95%CI，10.6%-3'0.5%）。与MRI和CT比较的有限数据显示，在诊断复发性和转移性疾病方面，（18）F-FDG PET与它们没有差异。