TY - JOUR T1 - Whole-Body <sup>18</sup>F-FDG PET and <sup>18</sup>F-FDG PET/CT in Patients with Suspected Paraneoplastic Syndrome: A Systematic Review and Meta-Analysis of Diagnostic Accuracy JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1031 LP - 1036 DO - 10.2967/jnumed.116.183905 VL - 58 IS - 7 AU - Sara Sheikhbahaei AU - Charles V. Marcus AU - Roberto S. Fragomeni AU - Steven P. Rowe AU - Mehrbod S. Javadi AU - Lilja B. Solnes Y1 - 2017/07/01 UR - http://jnm.snmjournals.org/content/58/7/1031.abstract N2 - The purpose of this study was to assess the diagnostic performance of whole-body 18F-FDG PET or 18F-FDG PET/CT for detection of underlying malignancy in patients with clinically suspected neurologic and nonneurologic paraneoplastic syndromes. Methods: A systematic search was performed in PubMed (Medline), Embase, and Scopus (last updated November 2016) to identify relevant published studies reporting the performance of 18F-FDG PET or 18F-FDG PET/CT in patients with suspected paraneoplastic syndrome. Histopathologic confirmation or clinical follow-up was considered as the reference standard. Pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, and diagnostic odds ratio were calculated. A summary receiver-operating-characteristic curve was constructed, and the area under the curve (AUC) was determined along with the Q* index. Results: Twenty-one studies including a total of 1,293 individual patients suspected of having a paraneoplastic syndrome and who underwent 18F-FDG PET or 18F-FDG PET/CT examinations met our inclusion criteria. There was moderate to high heterogeneity among the included studies. The pooled sensitivity, specificity, and diagnostic odds ratio of 18F-FDG PET or 18F-FDG PET/CT for the detection of underlying malignancy were 0.81 (95% CI, 0.76–0.86), 0.88 (95% CI, 0.86–0.90), and 34.03 (95% CI, 18.76–61.72), respectively. The AUC and the Q* index were 0.916 (SE, 0.018) and 0.849, indicating excellent diagnostic accuracy. The diagnostic accuracy was slightly improved after studies with high applicability concerns were excluded (AUC, 0.931; SE, 0.020). In a subgroup analysis, 18F-FDG PET/CT was found to have a significantly higher specificity (0.89 vs. 0.79) than 18F-FDG PET alone, with no evidence of significant difference in the overall performance (AUC, 0.930 vs. 0.891; 2-tailed P value for difference, 0.31). Conclusion: This meta-analysis of available studies demonstrates that whole-body 18F-FDG PET or 18F-FDG PET/CT has high diagnostic accuracy and moderate to high sensitivity and specificity for detection of underlying malignancy in patients suspected of having a paraneoplastic syndrome. ER -