Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
World J Urol. 2018 Mar;36(3):331-340. doi: 10.1007/s00345-017-2168-4. Epub 2018 Jan 2.
We aimed to assess the diagnostic accuracy of C-11 choline and C-11 acetate positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging in bladder cancer (BC) patients through a systematic review and meta-analysis.
The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of C-11 choline and C-11 acetate PET/CT for LN staging in BC. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves.
Across 10 studies (282 patients), the pooled sensitivity was 0.66 (95% CI 0.54-0.75) without heterogeneity (χ = 12.4, p = 0.19) and a pooled specificity of 0.89 (95% CI 0.76-0.95) with heterogeneity (χ = 29.1, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.8 (95% CI 2.7-12.7) and negative likelihood ratio (LR-) of 0.39 (95% CI 0.28-0.53). The pooled diagnostic odds ratio (DOR) was 15 (95% CI 6-38). In meta-regression analysis, the study design (prospective vs retrospective) was the source of the study heterogeneity.
C-11 choline and C-11 acetate PET/CT shows a low sensitivity and moderate specificity for the detection of metastatic LNs in patients with BC. Moreover, heterogeneity among the studies should be considered a limitation. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of C-11 choline and C-11 acetate PET/CT for this purpose.
通过系统评价和荟萃分析，评估 C-11 胆碱和 C-11 乙酸正电子发射断层扫描/计算机断层扫描（PET/CT）在膀胱癌（BC）患者淋巴结（LN）分期中的诊断准确性。
检索 MEDLINE、EMBASE 和 Cochrane Library 数据库，检索时间为最早可检索日期至 2017 年 6 月 30 日，评估 C-11 胆碱和 C-11 乙酸 PET/CT 在 BC 患者 LN 分期中的诊断性能的研究。我们确定了研究间的敏感性和特异性，计算了阳性和阴性似然比（LR+和 LR-），并构建了综合受试者工作特征曲线。
10 项研究（282 例患者）的汇总敏感性为 0.66（95%CI 0.54-0.75），无异质性（χ2=12.4，p=0.19），汇总特异性为 0.89（95%CI 0.76-0.95），异质性（χ2=29.1，p=0.00）。似然比（LR）综合分析得出总体阳性似然比（LR+）为 5.8（95%CI 2.7-12.7），阴性似然比（LR-）为 0.39（95%CI 0.28-0.53）。汇总诊断优势比（DOR）为 15（95%CI 6-38）。在元回归分析中，研究设计（前瞻性与回顾性）是研究异质性的来源。
C-11 胆碱和 C-11 乙酸 PET/CT 对 BC 患者转移性 LN 的检测具有低敏感性和中等特异性。此外，研究间的异质性应被视为一个局限性。需要进一步的大型多中心研究来证实 C-11 胆碱和 C-11 乙酸 PET/CT 在此目的下的诊断准确性。
