Meta-analysis of the diagnostic performance of F-18-FDG pet in renal cell carcinoma

Aim. Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of (IF)-I-18-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. Materials and methods. A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CAN-CERLIT Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. Results. Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of F-18-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of (IF)-I-18-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % Cl, 0.75-0.95) and in metastases detection with S 0.72 (95 % Cl, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. Conclusions. The results of this meta-analysis suggest that (IF)-I-18-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.