Abstract
Objectives: Positron emission tomography (PET) using fluorodeoxyglucose (FDG) is useful for restaging renal cell carcinoma (RCC) and detecting metastatic diseases but is less satisfactory for detecting primary disease. We evaluated whether the integration of computed tomography (CT) scans with the PET system could increase the applicability of FDG-PET for RCC. Methods: The MEDLINE databases were searched for relevant studies published since 2001. Two reviewers independently assessed the methodological quality of each study identified. We then performed a meta-analysis of the sensitivity and specificity of FDG-PET findings as reported in all the selected studies. Results: Fourteen studies were eligible for inclusion. The pooled sensitivity and specificity of FDG-PET were 62% and 88% respectively, for renal lesions. For detecting extra-renal lesions, the pooled sensitivity and specificity of FDG-PET were 79% and 90%, respectively, based on the scans, and 84% and 91% based on the lesions. The use of a hybrid FDG-PET/CT to detect extra-renal lesions increased the pooled sensitivity and specificity to 91% and 88%, respectively, with good consistency. Conclusions: For RCC, combining the FDG-PET and CT systems is helpful for detecting extra-renal metastasis rather than renal lesions. The hybrid PET/CT system has comparable sensitivity and specificity with PET in detecting extra-renal lesions of RCC. Advances in knowledge: The FDG-PET and PET/CT systems are both useful for detecting extra-renal metastasis in renal cell carcinoma.
Highlights
Renal cell carcinoma (RCC) is the most common solid kidney cancer
The inclusion criteria were: (a) articles whose original language was English; (b) studies that evaluated metastases or primary renal tumors; (c) studies that included a minimum of 12 human patients; (d) studies that used dedicated positron emission tomography (PET) cameras, not coincidence cameras; (e) patients had undergone PET with 18F-FDG without other radiotracers; (f) clear specification of the reference test was provided; (g) data were included on the validity indexes of diagnostic studies, that is, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), or adequate data had been given so that we could calculate these values
Using the original values provided in the articles, we recalculated the data on the sensitivity, specificity, PPV, and NPV of FDG-PET for detecting both locoregional and distant metastases
Summary
Due to its high metastatic potential, accurate staging is important to determine the appropriate treatment for a patient[1]. Fluorodeoxyglucose (FDG)positron emission tomography (PET) is widely applied in detecting malignancy and predicting the prognosis, as well as in staging/restaging, and in therapeutic decision-making and monitoring of tumors[2,3]. Martinez de Llano et al.[4] evaluated the performance of FDG-PET in detecting primary, recurrent, and metastatic RCC, as reported in articles published before October 2004.
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