18F-FDG positron emission tomography for the assessment of histological response to neoadjuvant chemotherapy in osteosarcomas: A meta-analysis

PurposeThe purpose of this meta-analysis was to evaluate the predicting value of fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) in the assessment of histological response to neoadjuvant chemotherapy in patients with osteosarcomas.MethodsA detailed search was made in MEDLINE, EMBASE and the Web of Knowledge for relevant original articles published in English; methodological quality of the included studies were also assessed. Two reviewers extracted data independently. Sufficient data was presented to construct a 2 × 2 contingency table. Pooled sensitivity and specificity, positive and negative likelihood ratios were estimated. A summary receiver operating characteristic curve (SROC) was constructed with the Moses' constant of linear model. A χ2 test was performed to test for heterogeneity.ResultsEight studies comprising 178 patients met the inclusion criteria. The pooled sensitivity and specificity for standardized uptake values (SUV) after chemotherapy (SUV2) ≤ 2.5 were 0.734 (95% CI, 0.537–0.867) and 0.864 (95% CI, 0.510–0.975), for the ratio of standardized uptake values after (SUV2) to before (SUV1) chemotherapy SUV 2:1 ≤ 0.5 were 0.690 (95% CI, 0.497–0.833) and 0.653 (95% CI, 0.492–0.786), the positive and negative likelihood ratio (LR+/LR−) for SUV2 ≤ 2.5 were 5.397 (95% CI, 1.169–24.920) and 0.308 (95% CI, 0.165–0.577), for SUV 2:1 ≤ 0.5 were 1.989 (95% CI, 1.145–3.457) and 0.475 (95% CI, 0.247–0.915). There was no significant difference between-study heterogeneity for either LR + or LR− in any of these analyses. The area under the SROC curve for SUV2 ≤ 2.5 and SUV 2:1 ≤ 0.5 were 0.81 and 0.72, respectively.ConclusionsThe present meta-analysis showed that 18F-FDG PET-CT scan, as measured by the SUV before and after treatment, SUV2 ≤ 2.5 and SUV 2:1 ≤ 0.5 are valuable for predicting the histological response to chemotherapy. SUV2 ≤ 2.5 have better predicting performance than SUV 2:1 ≤ 0.5.