Update on Diagnostic Performance of PET/MRI in Gynecological Malignancies: A Systematic Review and Meta-Analysis.

Catherine Devine,Sanaz Javadi,Mayur Virarkar,Roland Bassett,Priya Bhosale,Silvana De Castro Faria

doi:10.5334/jbsr.1981

Abstract

Objective:The aim of this study was to assess the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) for gynecological cancers of the pelvis based on a systematic review and meta-analysis of published data.Patients and Methods:A systematic literature search for original diagnostic studies was performed using PubMed/MEDLINE, the Cochrane Library, Embase and Web of Science. The methodological quality of each study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data necessary for entry in 2 × 2 contingency tables were obtained, and patients, study, and imaging characteristics were extracted from the selected articles. Statistical analysis included data pooling, heterogeneity testing, sensitivity analyses, forest plotting, and summary receiver operating characteristic curve construction.Result:Twelve studies met our predefined inclusion criteria and were included in this study. Patient-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the receiver operating characteristic curve for 18F-FDG PET/MRI in diagnosis of gynecological malignancies were 74.2% (95% confidence interval, 66.2–80.8%), 89.8% (95% CI, 82.2–94.3%), 26 (95% CI, 10–67), and 0.834, respectively. On lesion-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the curve were 87.5% (95% CI, 75.8–94.0%), 88.2% (95% CI, 84.2–91.3%), 50 (95% CI, 23–111), and 0.922, respectively.Conclusions:Our meta-analysis demonstrated that 18F-FDG PET/MRI is a promising diagnostic method for primary tumors, nodal staging, and recurrence in patients with gynecological malignancies of the pelvis.

Highlights

Inclusion Criteria Studies were eligible for inclusion if 1) the diagnostic performance of positron emission tomography/magnetic resonance imaging (PET/MRI) for gynecological malignancies was clearly identified in the study; 2) the number of true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) results could be obtained from the article; and 3) the reference standard for malignancy was either histopathological analysis or imaging follow-up
Study Selection and Description The initial search yielded 36 articles on studies involving PET/MRI in patients with gynecological malignancies 12 of which were eligible for inclusion in our analyses
For 18F-FDG PET/MRI in diagnosis of gynecological malignancies, the pooled sensitivity rate was 74.2% (95% confidence interval (6), 66.2–80.8%), and the pooled specificity rate was 89.8%

Summary

Objective

24 Ovarian (n = 13), cervical (n = 7), Recurrence and endometrial (n = 4) cancer. 43 Ovarian (n = 23), cervical (n = 12), endometrial (n = 4), vulvar (n = 3), and vaginal (n = 1) cancers. Lesion-Level Analysis as described above, we included a total of eight lesionlevel groups from six articles. We performed two assessments of the heterogeneity of the studies the lesion-level data. Deeks’ funnel plot regression revealed no statistical evidence of publication bias in PET/MRI in lesion level data. The numbers of PET/MRI studies were, insufficient to allow for assessment of reporting bias

Patients and Methods

Results

Discussion