Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer

Purpose Despite the increasing number of publications concerning F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for staging of esophageal cancer and the increasing availability of this novel diagnostic modality, its exact role in preoperative staging of these tumors is still unknown. The aim of this study was to systematically review the literature regarding the diagnostic performance of FDG-PET in preoperative staging of patients with esophageal cancer, and to calculate summary estimates of its sensitivity and specificity. Methods The databases of PubMed, Embase, and Cochrane were searched for relevant studies. Two reviewers independently assessed the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed. Results Twelve studies met the inclusion criteria. The studies had several design deficiencies. Pooled sensitivity and specificity for the detection of locoregional metastases were 0.51 (95% Cl, 0.34 to 0.69) and 0.84 (95% Cl, 0.76 to 0.91), respectively. For distant metastases, pooled sensitivity and specificity were 0.67 (95% Cl, 0.58 to 0.76) and 0.97 (95% Cl, 0.90 to 1.0), respectively. Conclusion FDG-PET showed moderate sensitivity and specificity for the detection of locoregional metastases, and reasonable sensitivity and specificity in detection of distant lymphatic and hematogenous metastases. (C) 2004 by American Society of Clinical Oncology.