title: Assessing the role of ¹⁸F-FDG PET and ¹⁸F-FDG PET/CT in the diagnosis of soft tissue musculoskeletal malignancies: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Twelve years ago a meta-analysis evaluated the diagnostic performance of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in assessing musculoskeletal soft tissue lesions (MsSTL). Currently, PET/CT has substituted PET imaging; however, there has not been any published meta-analysis on the use of PET/CT or a comparison of PET/CT with PET in the diagnosis of MsSTL. Therefore, we conducted a meta-analysis to identify the current diagnostic performance of (18)F-FDG PET/CT and determine if there is added value when compared to PET.
  
  
  METHODS
  A systematic review of English articles was conducted, and MEDLINE PubMed, the Cochrane Library, and Embase were searched from 1996 to March 2015. Studies exploring the diagnostic accuracy of (18)F-FDG PET/CT (or dedicated PET) compared to histopathology in patients with MsSTL undergoing investigation for malignancy were included.
  
  
  RESULTS
  Our meta-analysis included 14 articles composed of 755 patients with 757 soft tissue lesions. There were 451 (60 %) malignant tumors and 306 benign lesions. The (18)F-FDG PET/CT (and dedicated PET) mean sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for diagnosing MsSTL were 0.96 (0.90, 1.00), 0.77 (0.67, 0.86), 0.88 (0.85, 0.91), 0.86 (0.78, 0.94), and 0.91 (0.83, 0.99), respectively. The posterior mean (95 % highest posterior density interval) for the AUC was 0.92 (0.88, 0.96). PET/CT had higher specificity, accuracy, and positive predictive value when compared to a dedicated PET (0.85, 0.89, and 0.91 vs 0.71, 0.85, and 0.82, respectively).
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT and dedicated PET are both highly accurate in the diagnosis of MsSTL. PET/CT is more accurate and specific and has a higher positive predictive value than PET.
authors.affiliation: Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, FCT 16.6005, Unit 1483, Houston, TX, 77030, USA. Ecetchebehere@mdanderson.org.|Department of Nuclear Medicine, Sirio Libanes Hospital, São Paulo, Brazil. Ecetchebehere@mdanderson.org.
authors.forename: Elba C
authors.initials: EC
authors.lastname: Etchebehere
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Hobbs
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Denái R
authors.initials: DR
authors.lastname: Milton
authors.affiliation: Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Malawi
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.affiliation: Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, FCT 16.6005, Unit 1483, Houston, TX, 77030, USA.
authors.forename: Homer A
authors.initials: HA
authors.lastname: Macapinlac
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D009379:Neoplasms, Muscle Tissue / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG; Meta-analysis; Musculoskeletal; PET/CT; Sarcoma; Soft tissue tumors