Diagnostic Performance of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in the Postchemotherapy Management of Patients with Seminoma: Systematic Review and Meta-Analysis

Abstract

Objective. To meta-analyze published data about the diagnostic performance of fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the postchemotherapy management of patients with seminoma. Methods. A comprehensive literature search of studies published through January 2014 on this topic was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity and specificity, positive and negative predictive values (PPV and NPV), accuracy, and area under the summary ROC curve (AUC) of 18F-FDG-PET or PET/CT on a per examination-based analysis were calculated. Subgroup analyses considering the size of residual/recurrent lesions were carried out. Results. Nine studies including 375 scans were selected. The pooled analysis provided the following results: sensitivity 78% (95% confidence interval (95% CI): 67–87%), specificity 86% (95% CI: 81–89%), PPV 58% (95% CI: 48–68%), NPV 94% (95% CI: 90–96%), and accuracy 84% (95% CI: 80–88%). The AUC was 0.90. A better diagnostic accuracy of 18F-FDG-PET or PET/CT in evaluating residual/recurrent lesions >3 cm compared to those <3 cm was found. Conclusions. 18F-FDG-PET and PET/CT were demonstrated to be accurate imaging methods in the postchemotherapy management of patients with seminoma; nevertheless possible sources of false-negative and false-positive results should be considered. The literature focusing on this setting still remains limited and cost-effectiveness analyses are warranted.

Positron‐emission tomography imaging in urological oncology: Current aspects and developments

“…Similar results were found by Treglia et al . showing a pooled sensitivity of 78% (95% CI 67–87), a specificity of 86% (95% CI 81–89), a PPV of 58% (95% CI 48–68), an NPV of 94% (95% CI 90–96) and an accuracy of 84% (95% CI 80–88) for 18 F‐FDG PET/CT . Based on these results, it can be concluded that negative 18 F‐FDG PET/CT findings of residual masses after chemotherapy in metastatic seminoma warrant follow up, whereas positive findings should lead to subsequent treatment, such as salvage surgery, as mentioned by current guidelines .…”

“…8 94% (95% CI 90-96) and an accuracy of 84% (95% CI 80-88) for 18 F-FDG PET/CT. 9 Based on these results, it can be concluded that negative 18 F-FDG PET/CT findings of residual masses after chemotherapy in metastatic seminoma warrant follow up, whereas positive findings should lead to subsequent treatment, such as salvage surgery, as mentioned by current guidelines. 2 In order to avoid false positive findings as a result of chemotherapy-induced inflammatory and granulomatous tissues, or false negative results as a result of temporary suppression of tumor cell activities, at least 6 weeks between the end of chemotherapy and 18 F-FDG PET/CT examination should be respected.…”

Update on advances in molecular PET in urological oncology

“…One systematic review and meta-analysis including 4 selected studies with a total of 130 patients evaluated the diagnostic accuracy of 18 F-FDG PET/CT for prediction of viable residual tumors after chemotherapy in patients with metastatic seminoma and demonstrated that it was superior to CT for determining tumor size and predicting tumor viability: sensitivity was 72 vs 63 %, specificity was 92 vs 59 %, positive predictive value (PPV) was 70 vs 28 %, and negative predictive value (NPV) was 93 vs 86 %, respectively [96]. Another recent systematic review and meta-analysis including 9 selected studies with a total of 375 patients showed that 18 F-FDG PET/CT had a pooled sensitivity of 78 % (95 % CI: 67–87 %), a specificity of 86 % (95 % CI: 81–89 %), a PPV of 58 % (95 % CI: 48–68 %), a NPV of 94 % (95 % CI: 90–96 %), and an accuracy of 84 % (95 % CI: 80–88 %) [97]. Based on these results, it can be concluded that negative 18 F-FDG PET/CT findings warrant follow-up if only to avoid inappropriate subsequent treatment (surgery, chemotherapy, or radiotherapy), whereas positive 18 F-FDG PET/CT findings suggest a high possibility of residual seminoma, though a false-positive result cannot be excluded in view of the low PPV.…”

PET/Computed Tomography in Renal, Bladder, and Testicular Cancer

“…Several prospective and retrospective studies evaluated the diagnostic performance of FDG-PET or PET/CT in the post chemotherapy management of patients with GCT 70,72,75–84 . Recently, Treglia et al published a meta-analysis about the diagnostic performance of FDG PET and PET/CT in the post chemotherapy management of patients with seminoma 85 . Nine studies including 375 scans were included.…”