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Meta-Analysis of the Performance of ¹⁸F-FDG PET in Primary Tumor Detection in Unknown Primary Tumors

¹ Department of Nuclear Medicine, Hospital Clínico San Carlos, Madrid, Spain
² Research Unit, Hospital Clínico San Carlos, Madrid, Spain

View larger version (34K): [in a new window]   FIGURE 1. Histopathology of metastasis from UPT as described by Daugaard (2) compared with meta-analysis pooled-data and restricted data. Meta-analysis restricted data excluded studies that only included patients with cervical lymphadenopathies (11,34,35) and patients with cervical lymphadenopathies of squamous cell carcinoma (13–15). Squamous cell Ca. = squamous cell carcinoma; Adenoca. = adenocarcinoma; Undifferentiated Ca. = undifferentiated carcinoma.

View larger version (17K): [in a new window]   FIGURE 2. Localization of primary tumors detected by 18F-FDG PET or by clinical follow-up in patients with UPT included in meta-analysis.

View larger version (14K): [in a new window]   FIGURE 3. Estimated values and 95% CI of sensitivity (A) and specificity (B) in different types of studies (type I, type II, type A, and type B) and in pooled data (global). Global = pooled data; type I = 18F-FDG PET was performed when all diagnostic procedures performed did not detect primary tumor; type II = 18F-FDG PET was compared with CT or MRI in double-blind study after negative results for primary tumor detection with other diagnostic procedures; type A = whole-body 18F-FDG PET study was performed; type B = 18F-FDG PET study only included head-neck-thorax region.

View larger version (16K): [in a new window]   FIGURE 4. ln OR in studies included in meta-analysis and in pooled data. Calculated values of ln OR and variance in all studies are shown as well as ln OR and 95% CI in pooled data.

View larger version (9K): [in a new window]   FIGURE 5. Summary ROC curve for primary tumor detection with 18F-FDG PET in patients with UPT based on 15 studies included in meta-analysis.

View larger version (15K): [in a new window]   FIGURE 6. Funnel plots of sensitivity and specificity. (A) Funnel plot of sensitivity shows no publication bias. (B) Funnel plot of specificity suggests presence of bias.