18F-fluorodeoxyglucose positron emission tomography in the diagnosis of malignancy in patients with paraneoplastic neurological syndrome: a systematic review and meta-analysis

  1. García Vicente, A.M. 9
  2. Delgado-Bolton, R.C. 12
  3. Amo-Salas, M. 3
  4. López-Fidalgo, J. 11
  5. Caresia Aróztegui, A.P. 8
  6. García Garzón, J.R. 10
  7. Orcajo Rincón, J. 5
  8. García Velloso, M.J. 4
  9. Alvárez Ruíz, S. 7
  10. de Arcocha Torres, M. 6
  1. 1 Centro de Investigación Biomédica de La Rioja
    info

    Centro de Investigación Biomédica de La Rioja

    Logroño, España

    ROR https://ror.org/03vfjzd38

  2. 2 Universidad de La Rioja
    info

    Universidad de La Rioja

    Logroño, España

    ROR https://ror.org/0553yr311

  3. 3 Universidad de Castilla-La Mancha
    info

    Universidad de Castilla-La Mancha

    Ciudad Real, España

    ROR https://ror.org/05r78ng12

  4. 4 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

  5. 5 Hospital General Universitario Gregorio Marañón
    info

    Hospital General Universitario Gregorio Marañón

    Madrid, España

    ROR https://ror.org/0111es613

  6. 6 Hospital Universitario Marqués de Valdecilla
    info

    Hospital Universitario Marqués de Valdecilla

    Santander, España

    ROR https://ror.org/01w4yqf75

  7. 7 Hospital Miguel Servet
    info

    Hospital Miguel Servet

    Zaragoza, España

    ROR https://ror.org/01r13mt55

  8. 8 Corporació Sanitària Parc Taulí
    info

    Corporació Sanitària Parc Taulí

    Barcelona, España

    ROR https://ror.org/02pg81z63

  9. 9 Hospital General de Ciudad Real
    info

    Hospital General de Ciudad Real

    Ciudad Real, España

    ROR https://ror.org/02f30ff69

  10. 10 Unitat PET/TC CETIR-ERESA, Barcelona, Spain
  11. 11 Universidad de Navarra
    info

    Universidad de Navarra

    Pamplona, España

    ROR https://ror.org/02rxc7m23

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Revista:
European Journal of Nuclear Medicine and Molecular Imaging

ISSN: 1619-7070

Año de publicación: 2017

Volumen: 44

Número: 9

Páginas: 1575-1587

Tipo: Artículo

DOI: 10.1007/S00259-017-3722-4 SCOPUS: 2-s2.0-85019709005 WoS: WOS:000405459500018 GOOGLE SCHOLAR

Otras publicaciones en: European Journal of Nuclear Medicine and Molecular Imaging

Resumen

Purpose: The detection of occult cancer in patients suspected of having a paraneoplastic neurological syndrome (PNS) poses a diagnostic challenge. The aim of our study was to perform a systematic review and meta-analysis to assess the diagnostic performance of FDG PET for the detection of occult malignant disease responsible for PNS. Methods: A systematic review of the literature (MEDLINE, EMBASE, Cochrane, and DARE) was undertaken to identify studies published in any language. The search strategy was structured after addressing clinical questions regarding the validity or usefulness of the test, following the PICO framework. Inclusion criteria were studies involving patients with PNS in whom FDG PET was performed to detect malignancy, and which reported sufficient primary data to allow calculation of diagnostic accuracy parameters. When possible, a meta-analysis was performed to calculate the joint sensitivity, specificity, and detection rate for malignancy (with 95% confidence intervals [CIs]), as well as a subgroup analysis based on patient characteristics (antibodies, syndrome). Results: The comprehensive literature search revealed 700 references. Sixteen studies met the inclusion criteria and were ultimately selected. Most of the studies were retrospective (12/16). For the quality assessment, the QUADAS-2 tool was applied to assess the risk of bias. Across 16 studies (793 patients), the joint sensitivity, specificity, and detection rate for malignancy with FDG PET were 0.87 (95% CI: 0.80–0.93), 0.86 (95% CI: 0.83–0.89), and 14.9% (95% CI: 11.5–18.7), respectively. The area under the curve (AUC) of the summary ROC curve was 0.917. Homogeneity of results was observed for sensitivity but not for specificity. Some of the individual studies showed large 95% CIs as a result of small sample size. Conclusions: The results of our meta-analysis reveal high diagnostic performance of FDG PET in the detection of malignancy responsible for PNS, not affected by the presence of onconeural antibodies or clinical characteristics. © 2017, Springer-Verlag Berlin Heidelberg.