title: An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review.
abstract: BACKGROUND
  Rhabdomyosarcoma (RMS) management depends on risk stratification at diagnosis and treatment response. Assessment methods include CT, MRI, bone scintigraphy, histological analysis and bone marrow biopsy. Advanced functional imaging (FI) has potential to improve staging accuracy and management strategies.
  
  
  METHODS
  We conducted a systematic review (PROSPERO 2013:CRD42013006128) of diagnostic accuracy and clinical effectiveness of FI in histologically proven paediatric RMS. PRISMA guidance was followed. We searched 10 databases to November 2013. Studies with ≥10 patients with RMS which compared positron emission tomography (PET), PET-CT or diffusion-weighted imaging (DWI) MRI to conventional imaging at any treatment stage were included. Study quality was assessed. Limited, heterogeneous effectiveness data required narrative synthesis, illustrated by plotting sensitivity and specificity in receiver operating curve (ROC) space.
  
  
  RESULTS
  Eight studies (six PET-CT, two PET) with 272 RMS patients in total were included. No DWI-MRI studies met inclusion criteria. Pooled estimates were not calculated due to sparseness of data. Limited evidence indicated initial PET-CT results were predictive of survival. PET-CT changed management of 7/40 patients. Nodal involvement PET-CT: sensitivity ranged from 80% to 100%; specificity from 89% to 100%. Distant metastatic involvement: PET-CT sensitivity ranged from 95% to 100%; specificity from 80% to100%. Data on metastases in different sites were sparse. Limited data were found on outcome prediction by PET-CT response.
  PET/PET-CT may increase initial staging accuracy in paediatric RMS, specifically in the detection of nodal involvement and distant metastatic spread. There is a need to further assess PET-CT for this population, ideally in a representative, unbiased and transparently selected cohort of patients.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Norman
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK.
authors.forename: Debra
authors.initials: D
authors.lastname: Fayter
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Lewis-Light
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Chisholm
authors.affiliation: Great Ormond Street Hospital, London, UK.
authors.forename: Kieran
authors.initials: K
authors.lastname: McHugh
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Levine
authors.affiliation: Children's Hospital for Wales, Cardiff, UK.
authors.forename: Meriel
authors.initials: M
authors.lastname: Jenney
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Mandeville
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Gatz
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
mesh_terms: D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D049268:Positron-Emission Tomography / Q000592:standards*; D019275:Radiopharmaceuticals; D012208:Rhabdomyosarcoma / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*
chemical_list: D019275:Radiopharmaceuticals