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| Role of 18F-FDG PET and PET/CT in detection of unknown primary tumor:a systematic review and Meta-analysis of the literature |
| YANG Zhong-yi, XU Jun-yan, HU Si-long |
| Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China |
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Abstract Objective: To evaluate the diagnostic accuracy of 18F-FDG PET and PET/CT in the detection of primary tumors. Methods: Publications were collected from the English and Chinese literatures on PET or PET/CT imaging in detecting primary tumors of patients presenting with carcinoma of unknown primary(CUP) unidentified by conventional workup(before March 31, 2010). Systematic methods were used to identify, select, and evaluate the methodological quality of the studies. The pooled sensitivity, specificity, positive likelihood ratio(LR+), negative likelihood ratio(LR-), diagnostic odds ratio(DOR) and summary receiver operating characteristic(SROC) curves were obtained through Meta analysis. Results: 24 studies were analyzed(14 studies of PET and 10 studies of PET/CT). The detection capacity of the primary tumor of PET and PET/CT was 40.86%(344/842); 37.60%(144/383) for PET and 43.57%(200/459) for PET/CT, respectively. The primary tumors detected by PET and PET/CT mostly located in lung, tonsil and gastrointestinal tract. The pooled sensitivity, specificity, LR+, LR- and DOR of PET were 88%(82%~92%), 80%(74%～85%), 3.55(2.14～5.88), 0.24(0.16～0.36) and 24.94(11.36～54.78), respectively. As for PET/CT, there were 90%(86%~94%), 84%(79%～89%), 5.19(3.48～7.74), 0.07(0.02～0.25) and 80.02(20.42～313.48), respectively. The areas under the curve in SROC were 0.9074 and 0.8758, respectively. Q* value were 0.8393 and 0.8063, respectively. False positive was mostly seen in lung, tonsil and oropharynx. However, false negative was mostly seen in breast, tonsil, base of tongue and bone. Conclusion: 18F-FDG PET and PET/CT could be valuable imaging modalities in patients with CUP beyond what was provided from a conventional workup.
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Received: 25 September 2010
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Corresponding Authors:
HU Si-long
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2011, Vol. 22 
