Quantitative 201thallium scintigraphy for prediction of histological response to neoadjuvant chemotherapy in osteosarcoma; systematic review and meta-analysis

• 201Tl scintigraphy is useful to predict chemotherapy response of osteosarcoma.
• 201Tl scintigraphy is capable to differentiate active residual disease from necrosis.
• Our findings may change the current treatment strategy for osteosarcoma.
• The standardized and optimized methodology of 201Tl scintigraphy is needed.

PurposeThe histological assessment of tumor necrosis of the excised lesion after neoadjuvant chemotherapy is the most important prognostic factor for patients with osteosarcoma, but more early prognostic factors are needed for the adjustment of adjuvant treatment regimen. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of 201thallium (201Tl) scintigraphy for the preoperative evaluation of the chemotherapy response of osteosarcoma.MethodsStudies evaluating 201Tl scintigraphy for the preoperative evaluation of the chemotherapy response of osteosarcoma were systematically searched for in MEDLINE, EMBASE, and Web of Science. Pooled sensitivity and specificity for each study were calculated into 2 × 2 contingency tables. The DerSimonian-Laird random-effects method was used for determining the pooled diagnostic odds ratio and the area under curve (AUC) of the summary receiver operating characteristic (SROC) curve.ResultsA total of six studies with 139 patients who fulfilled all of the inclusion criteria were considered for the meta-analysis. The pooled sensitivity and specificity were 0.93 (95% CI, 0.83–0.98) and 0.63 (95% CI, 0.52–0.74), respectively. A significant difference was found between the good and poor responders in the diagnostic odds ratio. The SROC curve showed that the AUC was 0.840, indicating excellent diagnostic accuracy. There was no statistically significant heterogeneity among the six studies.ConclusionsThe alteration ratio derived from 201Tl scintigraphy was useful for evaluating the histological response of patients to neoadjuvant chemotherapy in osteosarcoma.