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Review
. 2021 Nov 9;11(11):CD012325.
doi: 10.1002/14651858.CD012325.pub2.

Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) for the detection of bone, lung, and lymph node metastases in rhabdomyosarcoma

Bas Vaarwerk  1   2 , Willemijn B Breunis  2   3 , Lianne M Haveman  1   2 , Bart de Keizer  1 , Nina Jehanno  4 , Lise Borgwardt  5 , Rick R van Rijn  6 , Henk van den Berg  2 , Jérémie F Cohen  7   8 , Elvira C van Dalen  1 , Johannes Hm Merks  1   2
Affiliations
Review

Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) for the detection of bone, lung, and lymph node metastases in rhabdomyosarcoma

Bas Vaarwerk et al. Cochrane Database Syst Rev. .

Abstract

Background: Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma and can emerge throughout the whole body. For patients with newly diagnosed RMS, prognosis for survival depends on multiple factors such as histology, tumour site, and extent of the disease. Patients with metastatic disease at diagnosis have impaired prognosis compared to those with localised disease. Appropriate staging at diagnosis therefore plays an important role in choosing the right treatment regimen for an individual patient. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is a functional molecular imaging technique that uses the increased glycolysis of cancer cells to visualise both structural information and metabolic activity. 18F-FDG-PET combined with computed tomography (CT) could help to accurately stage the extent of disease in patients with newly diagnosed RMS. In this review we aimed to evaluate whether 18F-FDG-PET could replace other imaging modalities for the staging of distant metastases in RMS.

Objectives: To determine the diagnostic accuracy of 18F-FDG-PET/CT imaging for the detection of bone, lung, and lymph node metastases in RMS patients at first diagnosis.

Search methods: We searched MEDLINE in PubMed (from 1966 to 23 December 2020) and Embase in Ovid (from 1980 to 23 December 2020) for potentially relevant studies. We also checked the reference lists of relevant studies and review articles; scanned conference proceedings; and contacted the authors of included studies and other experts in the field of RMS for information about any ongoing or unpublished studies. We did not impose any language restrictions.

Selection criteria: We included cross-sectional studies involving patients with newly diagnosed proven RMS, either prospective or retrospective, if they reported the diagnostic accuracy of 18F-FDG-PET/CT in diagnosing lymph node involvement or bone metastases or lung metastases or a combination of these metastases. We included studies that compared the results of the 18F-FDG-PET/CT imaging with those of histology or with evaluation by a multidisciplinary tumour board as reference standard.

Data collection and analysis: Two review authors independently performed study selection, data extraction, and methodological quality assessement according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). We analysed data for the three outcomes (nodal involvement and lung and bone metastases) separately. We used data from the 2 × 2 tables (consisting of true positives, false positives, true negatives, and false negatives) to calculate sensitivity and specificity in each study and corresponding 95% confidence intervals. We did not consider a formal meta-analysis to be relevant because of the small number of studies and substantial heterogeneity between studies.

Main results: Two studies met our inclusion criteria. The diagnostic accuracy of 18F-FDG-PET/CT was reported in both studies, which included a total of 36 participants. We considered both studies to be at high risk of bias for the domain reference standard. We considered one study to be at high risk of bias for the domain index test and flow and timing. Sensitivity and specificity of 18F-FDG-PET/CT for the detection of bone metastases was 100% in both studies (95% confidence interval (CI) for sensitivity was 29% to 100% in study one and 40% to 100% in study two; 95% CI for specificity was 83% to 100% in study one and 66% to 100% in study two). The reported sensitivity of 18F-FDG-PET/CT for the detection of lung metastases was not calculated since only two participants in study two showed lung metastases, of which one was detected by 18F-FDG-PET/CT. Reported specificity was 96% in study one (95% CI 78% to 100%) and 100% (95% CI 72% to 100%) in study two. The reported sensitivity for the detection of nodal involvement was 100% (95% CI 63% to 100% in study one and 40% to 100% in study two); the reported specificity was 100% (95% CI 78% to 100%) in study one and 89% (95% CI 52% to 100%) in study two.

Authors' conclusions: The diagnostic accuracy of 18F-FDG-PET/CT for the detection of bone, lung, and lymph node metastases was reported in only two studies including a total of only 36 participants with newly diagnosed RMS. Because of the small number of studies (and participants), there is currently insufficient evidence to reliably determine the diagnostic accuracy of 18F-FDG-PET/CT in the detection of distant metastases. Larger series evaluating the diagnostic accuracy of 18F-FDG-PET/CT for the detection of metastases in patients with RMS are necessary.

PubMed Disclaimer

Conflict of interest statement

JHM: None known BV: None known WBB: None known LMH: None known BdK: None known NJ: None known LB: None known RRvR: None known HvdB: None known JFC: None known ECvD: None known

Figures

1
1
Criteria used to define studies eligible for this review. 18F‐FDG‐PET/CT: fluorine‐18‐fluorodeoxyglucose ‐ positron emission tomography/computed tomography; CT: computed tomography; MRI: magnetic resonance imaging; RMS: rhabdomyosarcoma.
2
2
Study flow diagram. Abbreviations: ASCO, the American Society of Clinical Oncology; ASPHO, the American Society of Pediatric Hematology/Oncology; CTOS, the Connective Tissue Oncology Society; EMSOS, the European Musculo‐Skeletal Oncology Society; SIOP, the International Society for Paediatric Oncology.
3
3
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
4
4
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
5
5
Forest plot for the accuracy of 18F‐FDG‐PET/CT for the detection of bone metastases, lung metastases, and nodal involvement. Sensitivity for lung metastases based on one true‐positive and one false‐positive lesion, therefore not reported in text.
1
1. Test
18F‐FDG‐PET/CT for detection of bone metastases
2
2. Test
18F‐FDG PET/CT for detection of lung metastases
3
3. Test
18F‐FDG PET/CT for detection of nodal involvement
See this image and copyright information in PMC

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References

References to studies included in this review

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Sorschag 2011 {published data only}
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References to studies awaiting assessment

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