TABLE 5

Study Quality Assessment with Methodologic Quality Criteria Guidelines*

Guideline	Study										Guideline (%)
Guideline		Rege et al. (5)	Kole et al. (16)	Hanasono et al. (13)	Greven et al. (15)	Lassen et al. (8)	Gupta et al. (12)	Aassar et al. (35)	Bohuslavizki et al. (6)	Jungehülsing et al. (36)	Guideline (%)
Guideline 1: description of study design and patient selection criteria
1.Study design	A	A	A	A	A	P	A	A	A	A = 70.37 P = 25.93 N = 3.85
2.Patient selection criteria	P	A	P	P	A	P	P	A	A
3.Exclusion of patients from study’s final analysis	A	A	A	A	A	N	P	A	A
Guideline 2: characteristics of patient population finally studied
1.Mean age with range and sex	A	A	N	N	A	P	A	A	A	A = 55.55 P = 4.44 N = 40.00
2.Comorbid conditions	N	N	N	N	N	N	N	N	N
3.Diabetes mellitus	N	N	N	N	N	N	N	P	N
4.Localization of metastasis of UPT	A	A	A	A	A	A	A	A	A
5.Special institution characteristics	A	A	A	A	A	A	A	A	A
Guideline 3: patient indications leading to use of ¹⁸F-FDG PET
1.Reasons for use of ¹⁸F-FDG PET	A	A	A	A	A	A	A	A	A	A = 100.00
2.Reasons for use of ¹⁸F-FDG PET correlated with specific ¹⁸F-FDG PET findings	A	A	A	A	A	A	A	A	A
3.Extent of metastatic disease in every patient	A	A	A	A	A	A	A	A	A
Guideline 4: details of technologies used during study and image-interpretation issues
1.Imaging techniques used in study and resolution	A	A	P	A	P	A	A	A	A	A = 62.50 P = 16.67 N = 20.83
2.Patient preparation	N	A	N	A	A	A	A	A	A
3.Minimum 4-h fasting before ¹⁸F-FDG injection	N	A	N	A	A	A	A	A	A
4.Blood glucose level checked before ¹⁸F-FDG injection	N	N	N	N	P	N	N	N	A
5.Attenuation correction	A	P	A	A	P	A	A	P	A
6.Explanation of special characteristics of interpreters	A	N	A	A	A	P	A	N	N
7.Definition of positive and negative ¹⁸F-FDG PET findings	A	A	A	A	A	P	P	P	N
8.Additional scans	A	A	A	A	P	A	A	P	A
Guideline 5: final diagnostic confirmation
1.Final confirmation	A	A	A	A	A	A	A	A	A	A = 82.22 P = 6.67 N = 11.11
2.Association between specific ¹⁸F-FDG PET finding and final confirmation technique used	A	A	P	A	A	A	A	A	A
3.Histopathologic confirmation	A	A	A	A	A	A	A	A	A
4.Nonhistopathologic confirmation	N	A	A	A	P	A	A	A	A
5.Patients lost to clinical follow-up confirmation	N	N	N	A	A	N	P	A	A
Guideline 6: sensitivity and specificity data
1.Description of TP, FP, TN, and FN	P	P	A	A	A	P	A	A	P	A = 57.14 P = 22.22 N = 20.63
2.Qualitative explanation of FP and FN	N	A	N	A	P	P	A	P	A
3.Specific region studied by ¹⁸F-FDG PET	P	A	A	P	A	A	P	A	P
4.Location and no. of primary tumors and other metastatic lesions detected by ¹⁸F-FDG PET	A	A	P	A	A	A	A	A	A
5.Confidence intervals	N	N	N	N	N	N	N	N	N
6.Equivocal ¹⁸F-FDG PET findings	N	A	N	A	A	P	A	A	A
7.Data reported in patients and in corresponding lesions	A	A	P	A	A	A	A	A	A
Guideline 7: change-in-management information
1.¹⁸F-FDG PET-directed change in management	N/A	A	N/A	N/A	A	P	N/A	A	A	A = 77.14 P = 17.14 N = 5.71
2.Diagnostic tool used to make initial treatment decision	N/A	P	N/A	N/A	A	P	N/A	P	A
3.Diagnostic tool used to make final treatment decision	N/A	A	N/A	N/A	A	P	N/A	A	A
4.Medical treatment made both initially and after ¹⁸F-FDG PET	N/A	P	N/A	N/A	A	N	N/A	N	A
5.Correct or incorrect ¹⁸F-FDG PET-directed management change	N/A	A	N/A	N/A	A	A	N/A	A	A
6.Upstaging and downstaging	N/A	A	N/A	N/A	A	A	N/A	A	A
7.¹⁸F-FDG PET in management algorithm	N/A	A	N/A	N/A	A	A	N/A	A	A
Percentage of scores for each article
A (%)	58.06	73.68	51.61	77.42	76.31	55.26	70.97	71.05	81.58
P (%)	9.68	10.53	16.13	6.45	15.79	28.95	16.13	15.79	5.26
N (%)	32.26	15.79	32.26	16.13	7.89	15.79	12.90	13.16	13.16

↵* Methodologic quality criteria guidelines formulated by Huebner et al. (25) and adapted for review of studies of patients with UPT in which ¹⁸F-FDG PET is performed to detect primary tumor.
A = adequate adherence; P = partial adherence; N = not addressed; N/A = not applicable; TP = true-positive; FP = false-positive; TN = true-negative; FN = false-negative.