¹⁸F‐FDG PET and PET/CT as a diagnostic method for Ewing sarcoma: A systematic review and meta‐analysis

Abstract

Purpose:The aim of this study was to evaluate the diagnostic accuracy of 18fluorodeoxyglucose-positron emission tomography ( 18 F-FDG PET) and PET/computed tomography (PET/CT) in imaging primary and metastatic lesions in Ewing sarcoma (ES).Methods: PubMed, Cochrane, Scopus, and Web of Science were searched for relevant studies. Data concerning 18 F-FDG PET/CT diagnostic accuracy were extracted and then analyzed using Open Meta-analyst software. Reported diagnostic accuracy outcomes included sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), and diagnostic odds ratio.Results: Thirty-one studies with a total of 735 patients were included in this metaanalysis. The sensitivity and specificity of 18 F-FDG PET/CT were: 92.6% and 74.1% for total ES lesions, 96.7% and 68.3% for ES primary lesions, 76.1% and 92.4% for lung metastasis, 83.9% and 93.2% for bone metastasis, and 89.9% and 92.6% for ES recurrence, respectively. Conclusion:18 F-FDG PET/CT is sensitive and accurate in diagnosing, staging, and detecting the recurrence of ES compared with non-PET imaging. It has high accuracy for diagnosing recurrence of ES in bone metastases; however, CT remains a superior diagnostic method for detecting lung metastasis.

Ewing’s sarcoma of the right kidney with multiple metastasis on PET/CT

“…18 F FDG PET/CT has shown to help to localize the primary sarcoma, its extension, metastasis specially the bony and pulmonary metastasis and to check the response to standard treatment available [8]. It also allows the detection of progression or regression and recurrence of disease prior to anatomic imaging [8,9].…”

The Impact of PET/CT on Paediatric Oncology

“…The overall sensitivity for detecting lymph node metastases was 79.3% (95% CI: 58.7-91.2%) and the specificity was 97.9% (95% CI: 93.5-99.3%). Not surprisingly, the overall sensitivity for detecting lung metastases was low at 76.1% (95% CI: 61.4-86.5%), and the overall specificity was 92.4% (95% CI: 86.3-95.9%) [54].…”

Consensus recommendations in the management of Ewing sarcoma from the National Ewing Sarcoma Tumor Board

“…7 Additional reports have corroborated these findings. 8,9 Although many centers have access to FDG-PET, and data have demonstrated the superiority of FDG-PET over bone scintigraphy for the detection of bone metastases in these patients, 10 some centers without FDG-PET may continue to use bone scintigraphy or other modalities, such as whole-body MRI. Whereas FDG-PET-MRI is an active area of investigation, [11][12][13] and one study has demonstrated excellent concordance between PET-CT (sensitivity, 90.0%; specificity, 100%) and PET-MRI (sensitivity, 97.5%; specificity, 99.4%), 14 no firm conclusions can be made about the utility of FDG-PET-MRI at this time.…”