Abstract
Purpose. The diagnostic performance of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in detecting nodal involvement in patients with anal canal cancer (ACC) has been investigated by several studies with conflicting results. The aim of our study is to systematically review and meta-analyze published data about this topic. Methods. A comprehensive computer literature search of PubMed/MEDLINE, Scopus, and Embase databases was carried out on July 10 to find relevant articles concerning the diagnostic performance of FDG-PET in detecting locoregional nodal involvement in patients with ACC. No language restriction was used. Pooled diagnostic performance on a lesion-based analysis was calculated. Results. Seven retrospective and five prospective studies have been reviewed. Six studies allowed assessing pooled sensitivity; five studies allowed assessing pooled specificity. Sensitivity and specificity values of FDG-PET/CT on a lesion-based analysis ranged from 31 to 100% and from 53 to 98%, with pooled estimates of 56% (95% CI: 45–67%) and 90% (95% CI: 86–93%), respectively. Conclusions. Our meta-analysis demonstrates that FDG-PET is a specific diagnostic tool in detecting locoregional lymph node involvement in patients with ACC. Low sensitivity is a major concern; however, higher sensitivity could be reached combining FDG-PET with MR scan.
Highlights
Anal canal cancer (ACC) is a relatively uncommon neoplasm, with an incidence of about 1–3 cases per 100,000 and accounting for about 2% of gastrointestinal malignancies [1,2,3]
Our meta-analysis demonstrates that FDG-PET is a specific diagnostic tool in detecting locoregional lymph node involvement in patients with anal canal cancer (ACC)
The aim of our study is to systematically review and meta-analyze published data about the diagnostic performance of PET/Conventional imaging (CT) using FDG in detecting locoregional lymph node involvement in patients with biopsy-proven ACC, in order to provide evidence-based data in this setting
Summary
Anal canal cancer (ACC) is a relatively uncommon neoplasm, with an incidence of about 1–3 cases per 100,000 and accounting for about 2% of gastrointestinal malignancies [1,2,3]. ACC incidence rates are significantly higher in HIV-infected men and women than in HIV-uninfected ones, especially when considering men with homosexual habits [4,5,6]. Fecal incontinence and frank pain while seated are common in locally advanced ACC. Such signs and symptoms of ACC are not specific for this disease, since more common benign conditions, like hemorrhoids, rectal solitary ulcer, or anal fissure, may arise the same way. ACC may be completely asymptomatic in about 20% of patients and incidentally discovered during rectal exam for prostate screening colonoscopy in patients at risk for colon-rectum cancer or even during surgical intervention for hemorrhoids
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