title: Osteomyelitis: antigranulocyte scintigraphy with 99mTC radiolabeled monoclonal antibodies for diagnosis-- meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis of the sensitivity and specificity of antigranulocyte scintigraphy with monoclonal antibodies (MoAbs) in the diagnosis of osteomyelitis across different patient groups and clinical settings.
  
  
  METHODS
  MEDLINE and EMBASE searches were conducted. Data on the diagnostic performance of antigranulocyte scintigraphy with MoAbs were combined. Weighted sensitivities and specificities were estimated by using a random-effects model that incorporated between-study heterogeneity and by constructing summary receiver operating characteristic (ROC) curves. The weighted positive and negative likelihood ratios (LRs) across studies were estimated. Data syntheses were performed for all patients and for various subgroups. The reference standard used in each individual study was accepted.
  
  
  RESULTS
  Nineteen nonoverlapping studies with a total of 714 examinations and reference standards of cell culture, histologic examination, clinical follow-up, and radiologic examination were eligible. The independent random-effects summary estimates of sensitivity and specificity were 81% (95% confidence interval [CI]: 70%, 88%) and 77% (95% CI: 66%, 86%), respectively, with statistically significant between-study heterogeneity (exact P < .001 for both metrics). In the summary ROC curve, a sensitivity of 81% corresponded to a specificity of 86%, and a specificity of 77% corresponded to a sensitivity of 87%. The weighted positive LR was 3.02 (95% CI: 2.07, 4.42), and the weighted negative LR was 0.26 (95% CI: 0.17, 0.39), with statistically significant between-study heterogeneity (exact P < .001 for both metrics). Sensitivity was better for peripheral than for axial skeleton lesions (87% vs 53%).
  
  
  CONCLUSIONS
  Antigranulocyte scintigraphy with MoAbs has a sensitivity of 81% and a specificity of 77% in the diagnosis of osteomyelitis.
authors: Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University Hospital of Ioannina School of Medicine, University Campus, Ioannina, Epirus 45110, Greece.
authors: Emilios E
authors: EE
authors: Pakos
authors: Harry D
authors: HD
authors: Koumoullis
authors: Haris D
authors: HD
authors: Koumoulis
authors: Andreas D
authors: AD
authors: Fotopoulos
authors: John P A
authors: JP
authors: Ioannidis
mesh_terms: D000911:Antibodies, Monoclonal; D006098:Granulocytes / Q000276:immunology*; D006801:Humans; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013667:Technetium
chemical_list: D000911:Antibodies, Monoclonal; D013667:Technetium