Abstract
ObjectiveTo compare the value of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI) in differentiating benign and malignant ovarian or adnexal tumors.Materials and methodsEnglish articles reporting on the diagnostic performance of MRI or 18F-FDG PET/CT in identifying benign and malignant ovarian or adnexal tumors published in PubMed and Embase between January 2000 and January 2021 were included in the meta-analysis. Two authors independently extracted the data. If the data presented in the study report could be used to construct a 2 × 2 contingency table comparing 18F-FDG PET/CT and MRI, the studies were selected for the analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the included studies. Forest plots were generated according to the sensitivity and specificity of 18F-FDG PET/CT and MRI.ResultsA total of 27 articles, including 1118F-FDG PET/CT studies and 17 MRI studies on the differentiation of benign and malignant ovarian or adnexal tumors, were included in this meta-analysis. The pooled sensitivity and specificity for 18F-FDG PET/CT in differentiating benign and malignant ovarian or adnexal tumors were 0.94 (95% CI, 0.87–0.97) and 0.86 (95% CI, 0.79–0.91), respectively, and the pooled sensitivity and specificity for MRI were 0.92 (95% CI: 0.89–0.95) and 0.85 (95% CI: 0.79–0.89), respectively.ConclusionWhile MRI and 18F-FDG PET/CT both showed to have high and similar diagnostic performance in the differential diagnosis of benign and malignant ovarian or adnexal tumors, MRI, a promising non-radiation imaging technology, may be a more suitable choice for patients with ovarian or accessory tumors. Nonetheless, prospective studies directly comparing MRI and 18F-FDG PET/CT diagnostic performance in the differentiation of benign and malignant ovarian or adnexal tumors are needed.
Highlights
Ovarian cancer is the disease with the highest mortality rate among malignant tumors affecting the female reproductive tract
The pooled sensitivity and specificity for 18F-FDG PET/computed tomography (CT) in differentiating benign and malignant ovarian or adnexal tumors were 0.94 and 0.86, respectively, and the pooled sensitivity and specificity for magnetic resonance imaging (MRI) were 0.92 and 0.85, respectively
Ness et al have suggested that height (≥1.7 m) and body mass index ≥30 kg/m2 are high-risk factors, while tubal ligation and short-term use of intrauterine devices can reduce the risk of ovarian cancer [10]
Summary
Ovarian cancer is the disease with the highest mortality rate among malignant tumors affecting the female reproductive tract. The main risk factors for ovarian cancer are family genetic history, fertility factors, menstrual history, breastfeeding, height and body mass index, contraception, exercise, lifestyle, diet, gynecological diseases, psychological factors, and hormone replacement therapy [4,5,6,7,8]. Some studies suggested that smoking, a high-fat diet, ionizing radiation, talcum powder, and ABO blood type are risk factors for ovarian cancer [9,10,11]. Ness et al have suggested that height (≥1.7 m) and body mass index ≥30 kg/m2 are high-risk factors, while tubal ligation and short-term use of intrauterine devices can reduce the risk of ovarian cancer [10]. Braem et al [7] found that ovarian cancer was negatively correlated with increased parity, prolonged use of oral contraceptives, hysterectomy, younger age at natural menopause, exercise time, and annual shortening of menstrual cycles
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