Das K J, Meena J K, Kumar D
Dept. of Nuclear Medicine, National Cancer Institute (NCI-AIIMS), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Dept. of Preventive Oncology, National Cancer Institute (NCI-AIIMS), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Jpn J Radiol. 2025 Feb;43(2):266-281. doi: 10.1007/s11604-024-01659-4. Epub 2024 Sep 20.
Screening tests are the cornerstone for early detection and optimal management of cancers. Most of the present cancer-screening tests are intrusive, time-consuming, and specifically target a particular anatomical site or cancer type. Only a few studies have reported the objective measures of F-FDG PET-based cancer screening in asymptomatic individuals. This review and meta-analysis is an attempt to assess the applicability and performance of F-FDG PET-based modalities for whole-body cancer screening.
The systematic review and meta-analysis were performed following PRISMA guidelines. Literature searches in PubMed, Scopus, and Embase were conducted using relevant MeSH terms and keywords, for articles published in the last 2 decades (2000-2022). Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and hierarchical summary ROC (HSROC) curve were generated using bivariate random-effects meta-analysis.
Seventeen studies were included in the systematic review and 13 studies were deemed eligible for meta-analysis. The mean estimates of pooled sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and Odds ratio using F-FDG PET with a 95% confidence interval were 0.47 (0.25-0.69), 0.97 (0.95-0.98), 18.8 (6.8-51.5), 0.45 (0.27-0.76), 41.0 (7.9-211.8) and for F-FDG PET/CT were 0.83 (0.75-0.88), 0.98 (0.97-0.99), 49.7 (29.2-84.5), 0.15 (0.8-0.28), 329.9 (125.0-870.8), respectively. Among screening modalities, F-FDG PET/CT had a higher accuracy i.e., the area under the HSROC curve (AUC): 0.91 (0.87-0.95) compared to F-FDG PET: 0.72 (0.61-0.82).
This study demonstrates that currently F-FDG PET-based screening has limited applicability for population-based cancer-screening programs. However, it has a promising role as a combined screening strategy for at-risk individuals and allows for comprehensive diagnostic and prognostic evaluation in high-resource settings.
筛查测试是癌症早期检测和优化管理的基石。目前大多数癌症筛查测试具有侵入性、耗时，且专门针对特定的解剖部位或癌症类型。仅有少数研究报告了基于F-FDG PET的无症状个体癌症筛查的客观指标。本综述和荟萃分析旨在评估基于F-FDG PET的全身癌症筛查方法的适用性和性能。
按照PRISMA指南进行系统综述和荟萃分析。在PubMed、Scopus和Embase中使用相关医学主题词和关键词进行文献检索，检索过去20年（2000 - 2022年）发表的文章。采用双变量随机效应荟萃分析生成诊断测试准确性的合并估计值，包括敏感性、特异性、阳性似然比、阴性似然比和分层汇总ROC（HSROC）曲线。
系统综述纳入17项研究，13项研究被认为符合荟萃分析的条件。使用F-FDG PET时，合并敏感性、特异性、阳性似然比、阴性似然比和比值比的平均估计值及95%置信区间分别为0.47（0.25 - 0.69）、0.97（0.95 - 0.98）、18.8（6.8 - 51.5）、0.45（0.27 - 0.76）、41.0（7.9 - 211.8）；使用F-FDG PET/CT时分别为0.83（0.75 - 0.88）、0.98（0.97 - 0.99）、49.7（29.2 - 84.5）、0.15（0.08 - 0.28）、329.9（125.0 - 870.8）。在筛查方法中，F-FDG PET/CT的准确性更高，即HSROC曲线下面积（AUC）：0.91（0.87 - （此处原文有误，应为0.95）），而F-FDG PET为0.72（0.61 - 0.82）。
本研究表明，目前基于F-FDG PET的筛查在基于人群的癌症筛查项目中的适用性有限。然而，作为高危个体的联合筛查策略，它具有广阔的前景，并能在高资源环境中进行全面的诊断和预后评估。
