A metaanalysis of¹⁸F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma

BACKGROUND. In recent years, the use of positron emission tomography (PET) has become widespread for the staging and follow-up of several malignancies. In the current study, the authors conducted a metaanalysis of the published literature to evaluate the diagnostic performance of ¹⁸F-2-deoxy-2- fluoro-D-glucose PET (FDG-PET) in the staging of patients with lymphoma. METHODS. The authors conducted a systematic MEDLINE search of articles published between January 1995 and June 2004. Studies that evaluated FDG-PET with a dedicated camera and that reported sufficient data to permit the calculation of sensitivity and specificity were included in the analysis. Two reviewers independently reviewed the eligibility of the studies and abstracted data (sample population; characteristics of FDG-PET; and the number of true-positive results, true-negative results, false-positive results, and false-negative results). The authors estimated the pooled sensitivity, false-positive rate, and maximum joint sensitivity and specificity. RESULTS. Twenty studies were eligible for the metaanalysis. Fourteen studies included patient-based data, comprising a sample size of 854 subjects, and 7 studies included lesion-based data, totaling 3658 lesions. Among those studies with patient-based data, the median sensitivity was 90.3% and the median specificity was 91.1%. The pooled sensitivity was 90.9% (95% confidence interval [95% CI], 88.0-93.4) and the pooled false-positive rate was 10.3% (95% CI, 7.4-13.8). The maximum joint sensitivity and specificity was 87.8% (95% CI, 85.0-90.7). The pooled sensitivity and false-positive rate appeared to be higher in patients with Hodgkin disease compared with those with non-Hodgkin lymphoma. CONCLUSIONS. The results of the current study indicate that FDG-PET is a valuable tool for the staging and restaging of patients with lymphoma: showing a high positivity and specifity. Clinicians may consider adding FDG-PET to the staging workup of patients with lymphoma.