Performance of Whole-Body PET/CT for the Detection of Distant Malignancies in Various Cancers: A Systematic Review and Meta-Analysis

At present, there is no ideal imaging modality for the diagnosis of distant metastases and second primary cancers in cancer patients. We aimed to assess the accuracy of whole-body PET/CT for the overall assessment of distant malignancies in patients with various cancers. Methods: Studies about whole-body PET/CT for the detection of distant malignancies in cancer patients were systematically searched in MEDLINE and EMBASE. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios, and constructed summary receiver operating characteristic curves using hierarchical regression models for whole-body PET/CT. Results: Across 41 studies (4,305 patients), the sensitivity and specificity of whole-body PET/CT were 0.93 (95% confidence interval [Cl], 0.88-0.96) and 0.96 (95% Cl, 0.95-0.96), respectively. Subgroup analysis showed that the sensitivity and specificity of whole-body PET/CT for various cancers, respectively, were as follows: head and neck cancer, 0.90 (95% Cl, 0.83-0.95) and 0.95 (95% Cl, 0.94-0.96); lung cancer, 0.91 (95% Cl, 0.76-0.97) and 0.96 (95% Cl, 0.94-0.98); breast cancer, 0.97 (95% Cl, 0.93-0.99) and 0.95 (95% Cl, 0.90-0.97); and cancer of digestive system, 0.92 (95% Cl, 0.68-0.98) and 0.97 (95% Cl, 0.91-0.99). Conclusion: Whole-body PET/CT has excellent diagnostic performance for the overall assessment of distant malignancies in patients with various cancers, especially head and neck cancer, breast cancer, and lung cancer.