Impact of 18F-Fluorodeoxyglucose positron emission tomography on management of cancer of unknown primary: systematic review and meta-analysis
Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect a...
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| Veröffentlicht in: | European journal of cancer (1990) 2021-12, Vol.159, p.60-77 |
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| container_title | European journal of cancer (1990) |
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| creator | Woo, Sungmin Becker, Anton S. Do, Richard K.G. Schöder, Heiko Hricak, Hedvig Alberto Vargas, H. |
| description | Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP.
Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity.
Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%–40%). There was substantial heterogeneity among the studies (Q-test, p |
| doi_str_mv | 10.1016/j.ejca.2021.09.031 |
| format | Article |
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Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity.
Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%–40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% [95% CI 18–28%]) than detection of additional metastatic sites (14% [95% CI 10–19%]). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%–38.2%).
FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
•In 38 studies with cancer of unknown primary, 18F-fluoro-2-deoxyglucose positron emission tomography changed management 35%.c.•These were related to find the primary site (22%) or additional metastatic sites (14%).•Similar pooled proportions were seen across subgroups (32.8–38.2%).</description><identifier>ISSN: 0959-8049</identifier><identifier>EISSN: 1879-0852</identifier><identifier>DOI: 10.1016/j.ejca.2021.09.031</identifier><identifier>PMID: 34742159</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Cancer ; Cancer of unknown primary ; Computed tomography ; Confidence intervals ; Fluorine isotopes ; Heterogeneity ; Impact ; Magnetic resonance imaging ; Management ; Meta-analysis ; Metastases ; Patients ; Positron emission ; Positron emission tomography ; Quality assessment ; Subgroups ; Systematic review ; Tomography ; Tumors</subject><ispartof>European journal of cancer (1990), 2021-12, Vol.159, p.60-77</ispartof><rights>2021 Elsevier Ltd</rights><rights>Copyright Elsevier Science Ltd. Dec 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-cb6aa72cafcf9c9eb2394266faa9381bb2afcdc48de2ca706a41e4b967f30ea23</citedby><cites>FETCH-LOGICAL-c390t-cb6aa72cafcf9c9eb2394266faa9381bb2afcdc48de2ca706a41e4b967f30ea23</cites><orcidid>0000-0001-8459-8369 ; 0000-0003-2240-9694 ; 0000-0001-8372-6496 ; 0000-0002-6554-0310</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejca.2021.09.031$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids></links><search><creatorcontrib>Woo, Sungmin</creatorcontrib><creatorcontrib>Becker, Anton S.</creatorcontrib><creatorcontrib>Do, Richard K.G.</creatorcontrib><creatorcontrib>Schöder, Heiko</creatorcontrib><creatorcontrib>Hricak, Hedvig</creatorcontrib><creatorcontrib>Alberto Vargas, H.</creatorcontrib><title>Impact of 18F-Fluorodeoxyglucose positron emission tomography on management of cancer of unknown primary: systematic review and meta-analysis</title><title>European journal of cancer (1990)</title><description>Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP.
Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity.
Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%–40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% [95% CI 18–28%]) than detection of additional metastatic sites (14% [95% CI 10–19%]). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%–38.2%).
FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
•In 38 studies with cancer of unknown primary, 18F-fluoro-2-deoxyglucose positron emission tomography changed management 35%.c.•These were related to find the primary site (22%) or additional metastatic sites (14%).•Similar pooled proportions were seen across subgroups (32.8–38.2%).</description><subject>Cancer</subject><subject>Cancer of unknown primary</subject><subject>Computed tomography</subject><subject>Confidence intervals</subject><subject>Fluorine isotopes</subject><subject>Heterogeneity</subject><subject>Impact</subject><subject>Magnetic resonance imaging</subject><subject>Management</subject><subject>Meta-analysis</subject><subject>Metastases</subject><subject>Patients</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Quality assessment</subject><subject>Subgroups</subject><subject>Systematic review</subject><subject>Tomography</subject><subject>Tumors</subject><issn>0959-8049</issn><issn>1879-0852</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9UcuO1DAQtBCIHRZ-gJMlLlwS_MjLCCGhFQMrrcQFzlbH6cw6JHawk13yEfwznp0REhw4ua2uKlVXEfKSs5wzXr0ZchwM5IIJnjOVM8kfkR1vapWxphSPyY6pUmUNK9QFeRbjwBirm4I9JReyqAvBS7Ujv66nGcxCfU95s8_24-qD79D_3A7janxEOvtol-AdxcnGaNOw-MkfAsy3G02_CRwccEL3IGLAGQzHaXXfnb93dA52grC9pXGLC06wWEMD3lm8p-A6OuECWZIYt2jjc_KkhzHii_N7Sb7tP369-pzdfPl0ffXhJjNSsSUzbQVQCwO96ZVR2AqpClFVPYCSDW9bkTadKZoOE6hmFRQci1ZVdS8ZgpCX5P1Jd17bCTuTzAcY9dmq9mD13xtnb_XB3-mmqrmQdRJ4fRYI_seKcdEpHIPjCA79GrUokyFVS9kk6Kt_oINfQzo4oSohi1JVD4LihDLBxxiw_2OGM31sWw_62LY-tq2Z0qntRHp3ImHKKiUadDQWUwGdDWgW3Xn7P_pvxTK24Q</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Woo, Sungmin</creator><creator>Becker, Anton S.</creator><creator>Do, Richard K.G.</creator><creator>Schöder, Heiko</creator><creator>Hricak, Hedvig</creator><creator>Alberto Vargas, H.</creator><general>Elsevier Ltd</general><general>Elsevier Science Ltd</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8459-8369</orcidid><orcidid>https://orcid.org/0000-0003-2240-9694</orcidid><orcidid>https://orcid.org/0000-0001-8372-6496</orcidid><orcidid>https://orcid.org/0000-0002-6554-0310</orcidid></search><sort><creationdate>20211201</creationdate><title>Impact of 18F-Fluorodeoxyglucose positron emission tomography on management of cancer of unknown primary: systematic review and meta-analysis</title><author>Woo, Sungmin ; Becker, Anton S. ; Do, Richard K.G. ; Schöder, Heiko ; Hricak, Hedvig ; Alberto Vargas, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-cb6aa72cafcf9c9eb2394266faa9381bb2afcdc48de2ca706a41e4b967f30ea23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cancer</topic><topic>Cancer of unknown primary</topic><topic>Computed tomography</topic><topic>Confidence intervals</topic><topic>Fluorine isotopes</topic><topic>Heterogeneity</topic><topic>Impact</topic><topic>Magnetic resonance imaging</topic><topic>Management</topic><topic>Meta-analysis</topic><topic>Metastases</topic><topic>Patients</topic><topic>Positron emission</topic><topic>Positron emission tomography</topic><topic>Quality assessment</topic><topic>Subgroups</topic><topic>Systematic review</topic><topic>Tomography</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Woo, Sungmin</creatorcontrib><creatorcontrib>Becker, Anton S.</creatorcontrib><creatorcontrib>Do, Richard K.G.</creatorcontrib><creatorcontrib>Schöder, Heiko</creatorcontrib><creatorcontrib>Hricak, Hedvig</creatorcontrib><creatorcontrib>Alberto Vargas, H.</creatorcontrib><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of cancer (1990)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Woo, Sungmin</au><au>Becker, Anton S.</au><au>Do, Richard K.G.</au><au>Schöder, Heiko</au><au>Hricak, Hedvig</au><au>Alberto Vargas, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of 18F-Fluorodeoxyglucose positron emission tomography on management of cancer of unknown primary: systematic review and meta-analysis</atitle><jtitle>European journal of cancer (1990)</jtitle><date>2021-12-01</date><risdate>2021</risdate><volume>159</volume><spage>60</spage><epage>77</epage><pages>60-77</pages><issn>0959-8049</issn><eissn>1879-0852</eissn><abstract>Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP.
Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity.
Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%–40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% [95% CI 18–28%]) than detection of additional metastatic sites (14% [95% CI 10–19%]). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%–38.2%).
FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
•In 38 studies with cancer of unknown primary, 18F-fluoro-2-deoxyglucose positron emission tomography changed management 35%.c.•These were related to find the primary site (22%) or additional metastatic sites (14%).•Similar pooled proportions were seen across subgroups (32.8–38.2%).</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>34742159</pmid><doi>10.1016/j.ejca.2021.09.031</doi><tpages>18</tpages><orcidid>https://orcid.org/0000-0001-8459-8369</orcidid><orcidid>https://orcid.org/0000-0003-2240-9694</orcidid><orcidid>https://orcid.org/0000-0001-8372-6496</orcidid><orcidid>https://orcid.org/0000-0002-6554-0310</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cancer Cancer of unknown primary Computed tomography Confidence intervals Fluorine isotopes Heterogeneity Impact Magnetic resonance imaging Management Meta-analysis Metastases Patients Positron emission Positron emission tomography Quality assessment Subgroups Systematic review Tomography Tumors |
| title | Impact of 18F-Fluorodeoxyglucose positron emission tomography on management of cancer of unknown primary: systematic review and meta-analysis |
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