Abstract
PurposeThe aim of this study was to evaluate the diagnostic performance of choline positron emission tomography/computed tomography (PET/CT) for the detection of bone metastasis in patients with prostate cancer.MethodsMEDLINE, EMBASE and the Cochrane Library were searched up to 20 February 2018 for studies that used 11C-choline or 18F-choline PET/CT for the detection of bone metastasis in patients with prostate cancer and “histopathology and/or clinical follow-up” as the reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled diagnostic accuracy with the 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed hierarchical summary receiver operating characteristic curves and performed meta-regression analyses.ResultsFourteen studies with reasonable methodological quality were included in the analysis. On a per-patient basis, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.89 (95% CI 0.80–0.94), 0.98 (95% CI 0.95–0.99), 40.4 (95% CI 19.7–82.6), 0.12 (95% CI 0.07–0.20), and 344 (95% CI 148–803), respectively. On a per-lesion basis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.91 (95% CI 0.85–0.94), 0.97 (95% CI 0.95–0.98), 34.1 (95% CI 20.0–58.1), 0.10 (95% CI 0.06–0.16), and 358 (95% CI 165–778), respectively. In the meta-regression analysis, the clinical setting (staging vs. restaging) was the only source of study heterogeneity on a per-patient basis.ConclusionsCholine PET/CT shows excellent diagnostic performance for the detection of bone metastasis. However, a negative choline PET/CT result cannot ensure the lack of bone metastasis.
Highlights
Prostate cancer (PC) is the second most common malignancy in males worldwide, with an incidence of approximately 1.1 million cases per year [1, 2]
On a per-patient basis, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.89, 0.98, 40.4, 0.12, and 344, respectively
On a per-lesion basis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.91, 0.97, 34.1, 0.10, and 358, respectively
Summary
Prostate cancer (PC) is the second most common malignancy in males worldwide, with an incidence of approximately 1.1 million cases per year [1, 2]. 8–35% of PC patients at initial diagnosis and 65–75% of advanced PC patients will develop bone metastases [4,5,6]. It is critically important to accurately detect bone metastasis in order to select appropriate patient management. Most institutions use conventional imaging modalities such as bone scan (BS), computed tomography (CT) and magnetic resonance imaging (MRI) to detect bone metastases of PC. In recent decades, integrated PET/CT has emerged as a new modality for whole-body imaging; this modality provides both the metabolic processes and comprehensive morphological information in a single examination [10]. There have been many studies investigating choline PET/CT for the diagnosis of bone metastases in PC patients, the results from these studies remain inconsistent
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