Diagnostic performance of 18F-FDG PET or PET/CT in differential diagnosis of uterine leiomyomas and uterine sarcomas: systematic review and meta-analysis of the literature

Abstract

Objective: The radiological features of uterine mesenchymal tumors are sometimes similar, which makes differential diagnosis difficult. The aim of meta-analysis was to provide an overview of the literature on the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/computed tomography (CT) in differentiating between uterine leiomyomas and uterine sarcomas. Methods: A systematic search of the MEDLINE and EMBASE databases up to June 1, 2021, was performed. All studies that reported the diagnostic accuracy of 18F-FDG PET or PET/CT in differentiating between uterine leiomyomas and uterine sarcomas were considered eligible. Histological confirmation of surgical specimens or clinical confirmation by long-term follow-up examination was considered as the reference standard. Data on diagnostic accuracy were extracted or calculated and presented as forest plots. A bivariate random-effects model was used to calculate pooled estimates of sensitivity and specificity. Results: A total of seven studies with 196 patients were included for data extraction among initial 507 studies. The overall pooled estimates for sensitivity and specificity were 0.88 [95% confidence interval (CI) = 0.77–0.94] and 0.83 (95% CI = 0.76–0.89), respectively. Likelihood ratio (LR) syntheses yielded an overall positive LR of 4.24 (95% CI = 3.0–6.01) and negative LR of 0.22 (95% CI = 0.13–0.37). The pooled diagnostic odds ratio was 29.59 (95% CI = 12.42–70.49). The area under the hierarchical summary receiver operating characteristic curve was 0.87. Conclusion: This meta-analysis showed that 18F-FDG PET/CT is a good imaging modality for differentiating between uterine leiomyomas and uterine sarcomas. © 2022, The Author(s), under exclusive licence to Italian Association of Nuclear Medicine and Molecular Imaging.