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Meta-Analysis
. 2017 Dec;90(1080):20170370.
doi: 10.1259/bjr.20170370. Epub 2017 Oct 3.

PET imaging in anal canal cancer: a systematic review and meta-analysis

Aamer Mahmud  1 , Raymond Poon  2 , Derek Jonker  3
Affiliations
Meta-Analysis

PET imaging in anal canal cancer: a systematic review and meta-analysis

Aamer Mahmud et al. Br J Radiol. 2017 Dec.

Abstract

Objective: The aim of this study was to systematically review the literature to synthesize and summarize the evidence surrounding the clinical utility of positron emission tomography (PET) imaging in patients with anal canal cancer.

Methods: The literature was searched using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews databases. Studies comparing PET or PET/CT with conventional imaging in the staging, response evaluation and follow-up of anal canal cancer were deemed eligible for inclusion.

Results: 17 studies met the inclusion criteria. For the detection of primary tumour in situ, the pooled sensitivity was 99% for PET or PET/CT and 67% for CT. For the detection of inguinal lymph nodes, PET/CT had an overall sensitivity of 93% and specificity of 76%. PET or PET/CT upstaged 5.1 to 37.5% of patients and downstaged 8.2 to 26.7% of patients. Treatment plans were modified in 12.5 to 59.3% of patients, which consisted mainly of radiotherapy dose or field changes. Complete response on PET or PET/CT is a good prognostic factor for overall and progression-free survival.

Conclusions: PET/CT seems to add value to conventional imaging in the initial staging of patients with T2-4 disease but further high-quality research is required to validate this. There is insufficient evidence at this time to recommend a routine use of PET/CT in the assessment of treatment response or follow-up. Advances in knowledge: PET/CT appears to alter the disease stage and management in a meaningful number of patients to justify its use as part of staging investigations in locally advanced cases.

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Figures

Figure 1.
Figure 1.
Flow diagram of study selection; n denotes the number of citations.
Figure 2.
Figure 2.
Forest plot of the sensitivity of PET or PET/CT in the detection of primary tumour in situ.
Figure 3.
Figure 3.
Forest plot of the sensitivity of CT in the detection of primary tumour in situ.
Figure 4.
Figure 4.
Sensitivity of PET/CT in detecting inguinal lymph nodes.
Figure 5.
Figure 5.
Specificity of PET/CT in detecting inguinal lymph nodes.
See this image and copyright information in PMC

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