title: Whole-Body18F-FDG PET and18F-FDG PET/CT in Patients with Suspected Paraneoplastic Syndrome: A Systematic Review and Meta-Analysis of Diagnostic Accuracy.
abstract: The purpose of this study was to assess the diagnostic performance of whole-body18F-FDG PET or18F-FDG PET/CT for detection of underlying malignancy in patients with clinically suspected neurologic and nonneurologic paraneoplastic syndromes.Methods:A systematic search was performed in PubMed (Medline), Embase, and Scopus (last updated November 2016) to identify relevant published studies reporting the performance of18F-FDG PET or18F-FDG PET/CT in patients with suspected paraneoplastic syndrome. Histopathologic confirmation or clinical follow-up was considered as the reference standard. Pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, and diagnostic odds ratio were calculated. A summary receiver-operating-characteristic curve was constructed, and the area under the curve (AUC) was determined along with the Q* index.Results:Twenty-one studies including a total of 1,293 individual patients suspected of having a paraneoplastic syndrome and who underwent18F-FDG PET or18F-FDG PET/CT examinations met our inclusion criteria. There was moderate to high heterogeneity among the included studies. The pooled sensitivity, specificity, and diagnostic odds ratio of18F-FDG PET or18F-FDG PET/CT for the detection of underlying malignancy were 0.81 (95% CI, 0.76-0.86), 0.88 (95% CI, 0.86-0.90), and 34.03 (95% CI, 18.76-61.72), respectively. The AUC and the Q* index were 0.916 (SE, 0.018) and 0.849, indicating excellent diagnostic accuracy. The diagnostic accuracy was slightly improved after studies with high applicability concerns were excluded (AUC, 0.931; SE, 0.020). In a subgroup analysis,18F-FDG PET/CT was found to have a significantly higher specificity (0.89 vs. 0.79) than18F-FDG PET alone, with no evidence of significant difference in the overall performance (AUC, 0.930 vs. 0.891; 2-tailedPvalue for difference, 0.31).Conclusion:This meta-analysis of available studies demonstrates that whole-body18F-FDG PET or18F-FDG PET/CT has high diagnostic accuracy and moderate to high sensitivity and specificity for detection of underlying malignancy in patients suspected of having a paraneoplastic syndrome.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sara
authors.initials: S
authors.lastname: Sheikhbahaei
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Marcus
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Fragomeni
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Rowe
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mehrbod S
authors.initials: MS
authors.lastname: Javadi
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland lsolnes1@jhmi.edu.
authors.forename: Lilja B
authors.initials: LB
authors.lastname: Solnes
mesh_terms: D019788:Fluorodeoxyglucose F18; D015994:Incidence; D010257:Paraneoplastic Syndromes / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D051598:Whole Body Imaging / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG-PET; meta-analysis; paraneoplastic syndrome; sensitivity and specificity