Performance of pre-treatment (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis

OBJECTIVE: We describe a systematic review and meta-analysis of the performance of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS: MEDLINE and Embase were searched for diagnostic accuracy studies that used (18)F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61–0.81) and 0.93 (95% CI=0.85–0.97), respectively. There was considerable heterogeneity in sensitivity (I(2)=97.57%) and specificity (I(2)=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67–0.87 and 0.96; 95% CI=0.92–0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46–0.77 and 0.84; 95% CI=0.69–0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90–0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24–1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94–1.00) than those with a greater prevalence (0.89; 95% CI=0.80–0.97). CONCLUSION: Pre-treatment (18)F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.