The diagnostic performance of (18)F-FAMT PET and (18)F-FDG PET for malignancy detection: a meta-analysis

BACKGROUND: This meta-analysis aims to compare the diagnostic performance of l-3-(18)F-α-methyl tyrosine ((18)F-FAMT) positron emission tomography (PET) and 2-deoxy-2-[(18)F]fluoro-d-glucose ((18)F-FDG) PET for malignancy detection. METHODS: The workflow of this study follows Cochrane Collaboration Guidelines of a systematic review of diagnostic test accuracy studies. An electronic search was performed for clinical diagnostic studies directly comparing (18)F-FAMT and (18)F-FDG PET for malignant tumors. Study quality, the risks of bias and sources of variation among studies were assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) assessment tool. A separate meta-analysis was performed for diagnostic performance based on visual assessment and diagnostic cut-off values. Whenever possible, a bivariate random-effect model was used for analysis and pooling of diagnostic measures across studies. RESULTS: Electronic search revealed 56 peer-reviewed basic science investigations and clinical studies. Six eligible studies (272 patients) of various type of cancer were meta-analyzed. The (18)F-FAMT diagnostic accuracy for malignancy was higher than (18)F-FDG based on both visual assessment (diagnostic odd ratio (DOR): 8.90, 95% confidence interval (CI) [2.4, 32.5]) vs 4.63, 95% CI [1.8, 12.2], area under curve (AUC): 77.4% vs 72.8%) and diagnostic cut-off (DOR: 13.83, 95% CI [6.3, 30.6] vs 7.85, 95% CI [3.7, 16.8], AUC: 85.6% vs 80.2%), respectively. While the average sensitivity and specificity of (18)F-FAMT and (18)F-FDG based on visual assessment were similar, (18)F-FAMT was significantly more specific than (18)F-FDG (p < 0.05) based on diagnostic cut-off values. CONCLUSIONS: (18)F-FAMT is more specific for malignancy than (18)F-FDG, while their sensitivity is comparable. (18)F-FAMT PET is equal to (18)F-FDG PET in diagnostic performance for malignancy detection in several cancer types.