PT  - JOURNAL ARTICLE
AU  - Emilios E. Pakos
AU  - Andreas D. Fotopoulos
AU  - John P.A. Ioannidis
TI  - <sup>18</sup>F-FDG PET for Evaluation of Bone Marrow Infiltration in Staging of Lymphoma: A Meta-Analysis
DP  - 2005 Jun 01
TA  - Journal of Nuclear Medicine
PG  - 958--963
VI  - 46
IP  - 6
4099  - http://jnm.snmjournals.org/content/46/6/958.short
4100  - http://jnm.snmjournals.org/content/46/6/958.full
SO  - J Nucl Med2005 Jun 01; 46
AB  - The ability of PET with 18F-FDG to evaluate bone marrow infiltration in patients with lymphoma has been a matter of extensive investigation with controversial results. Therefore, we aimed to evaluate systematically, with a meta-analysis, the diagnostic performance of 18F-FDG PET in this setting. Methods: Relevant studies were identified with MEDLINE and EMBASE searches (last update, August 2004). Data on the diagnostic performance of 18F-FDG PET were combined quantitatively across eligible studies. We estimated weighted summary sensitivities and specificities, summary receiver-operating-characteristic (SROC) curves, and weighted summary likelihood ratios. We also conducted separate analyses according to various subgroups. Bone marrow biopsy (BMB) was used as the reference standard. Results: Thirteen eligible nonoverlapping studies, which enrolled a total of 587 patients, were included in the meta-analysis. The independent random-effects weighted estimates of sensitivity and specificity against BMB were 51% (95% confidence interval [CI], 38%–64%) and 91% (95% CI, 85%–95%), respectively. Results were consistent in the SROC curve: a sensitivity of 51% corresponds to a specificity of 92%, whereas a specificity of 91% corresponds to a sensitivity of 55%. The weighted positive likelihood ratio (LR+) was 5.75 (95% CI, 348–9.48) and the negative likelihood ratio (LR−) was 0.67 (95% CI, 0.55–0.82). Six of 12 patients with positive 18F-FDG PET and negative initial biopsy were found to have bone marrow involvement when biopsy was performed at the sites with positive imaging signals. Subgroup analyses showed better sensitivity in patients with Hodgkin’s disease and in aggressive histologic types of non-Hodgkin’s lymphoma than in patients with less aggressive histologic types and in studies using unilateral BMB compared with those using bilateral biopsy. Conclusion: This meta-analysis showed that 18F-FDG PET has good, but not excellent, concordance with the results of BMB for the detection of bone marrow infiltration in the staging of patients with lymphoma. 18F-FDG PET may complement the results of BMB and its performance may vary according to the type of lymphoma.