Cancer 2001 Apr 15;91(8):1530-42
Systematic review of the diagnostic accuracy of (18)F-fluorodeoxyglucose
positron emission tomography in melanoma patients.
Mijnhout GS, Hoekstra OS, van Tulder MW, Teule GJ, Deville WL.
BACKGROUND: Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG)
is a rapidly developing new imaging technique in the diagnosis and staging of
melanoma. The objective of the current study was to determine the diagnostic
accuracy of FDG-PET in patients with melanoma. METHODS: A systematic review and
meta-analysis of clinical studies regarding FDG-PET and cutaneous melanoma was
conducted. Studies were identified by a comprehensive search of the MEDLINE,
EMBASE, and Current Contents databases, without any language restrictions.
Eleven studies were selected. The methodologic quality of these studies was
assessed independently by two reviewers. Levels of evidence and grades of
recommendation were determined for each study. Six studies could be included in
the statistical pooling. Sources of heterogeneity were studied by
meta-regression of the diagnostic odds ratio (DOR). A summary receiver operating
characteristic curve was calculated. RESULTS: The pooled sensitivity and
specificity of FDG-PET in the detection of melanoma metastases were 0.79 (95%
confidence interval [95% CI], 0.66-0.93) and 0.86 (95% CI, 0.78-0.95),
respectively. The pooled DOR of 33.1 (95% CI, 21.9-54.0) suggests a high
diagnostic accuracy for PET. Subgroup analysis revealed that PET is more
accurate for systemic staging (DOR of 36.4) than for regional staging (DOR of
19.5). When used for regional staging, PET performed better in patients with
American Joint Committee on Cancer Stage III disease, compared with patients
with Stage I and Stage II disease. However, the methodologic quality of the
studies was limited. Major problems were verification, review, and selection
bias. CONCLUSIONS: Due to the poor methodologic quality of the available
studies, to the authors' knowledge it is yet not possible to develop guidelines
for the effective use of PET in patients with melanoma. Future accuracy studies
should meet the methodologic criteria outlined in the current review. Copyright
2001 American Cancer Society.
