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Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis.
Dis Esophagus. 2018 Dec 01; 31(12)DE

Abstract

Restaging after neoadjuvant therapy aims to reduce the number of patients undergoing esophagectomy in case of distant (interval) metastases. The aim of this study is to systematically review and meta-analyze the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 18F-FDG PET/CT for the detection of distant interval metastases after neoadjuvant therapy in patients with esophageal cancer. PubMed/MEDLINE, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies reporting on the detection of distant interval metastases with 18F-FDG PET(/CT) in patients with esophageal cancer who received neoadjuvant therapy and both baseline staging and restaging after neoadjuvant therapy with 18F-FDG PET(/CT) imaging. The primary outcome measure was the proportion of patients in whom distant interval metastases were detected by 18F-FDG PET(/CT) as confirmed by pathology or clinical follow-up (i.e. true positives). The secondary outcome measure was the proportion of patients in whom 18F-FDG PET(/CT) restaging was false positive for distant interval metastases (i.e. false positives). Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Random-effect models were used to estimate pooled outcomes and examine potential sources of heterogeneity. Fourteen studies were included comprising a total of 1,110 patients who received baseline staging with 18F-FDG PET(/CT) imaging of whom 1,001 (90%) underwent restaging with 18F-FDG PET(/CT) imaging. Studies were generally of moderate quality. The pooled proportion of patients in whom true distant interval metastases were detected by 18F-FDG PET(/CT) restaging was 8% (95% confidence interval [CI]: 5-13%). The pooled proportion of patients in whom false positive distant findings were detected by 18F-FDG PET(/CT) restaging was 5% (95% CI: 3-9%). In conclusion,18F-FDG PET(/CT) restaging after neoadjuvant therapy for esophageal cancer detects true distant interval metastases in 8% of patients. Therefore, 18F-FDG PET(/CT) restaging can considerably impact on treatment decision-making. However, false positive distant findings occur in 5% of patients at restaging with 18F-FDG PET(/CT), underlining the need for pathological confirmation of suspected lesions.

Authors+Show Affiliations

Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29917073

Citation

Kroese, T E., et al. "Detection of Distant Interval Metastases After Neoadjuvant Therapy for Esophageal Cancer With 18F-FDG PET(/CT): a Systematic Review and Meta-analysis." Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, vol. 31, no. 12, 2018.
Kroese TE, Goense L, van Hillegersberg R, et al. Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis. Dis Esophagus. 2018;31(12).
Kroese, T. E., Goense, L., van Hillegersberg, R., de Keizer, B., Mook, S., Ruurda, J. P., & van Rossum, P. S. N. (2018). Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis. Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, 31(12). https://doi.org/10.1093/dote/doy055
Kroese TE, et al. Detection of Distant Interval Metastases After Neoadjuvant Therapy for Esophageal Cancer With 18F-FDG PET(/CT): a Systematic Review and Meta-analysis. Dis Esophagus. 2018 Dec 1;31(12) PubMed PMID: 29917073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis. AU - Kroese,T E, AU - Goense,L, AU - van Hillegersberg,R, AU - de Keizer,B, AU - Mook,S, AU - Ruurda,J P, AU - van Rossum,P S N, PY - 2018/6/20/pubmed PY - 2019/4/10/medline PY - 2018/6/20/entrez JF - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus JO - Dis. Esophagus VL - 31 IS - 12 N2 - Restaging after neoadjuvant therapy aims to reduce the number of patients undergoing esophagectomy in case of distant (interval) metastases. The aim of this study is to systematically review and meta-analyze the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 18F-FDG PET/CT for the detection of distant interval metastases after neoadjuvant therapy in patients with esophageal cancer. PubMed/MEDLINE, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies reporting on the detection of distant interval metastases with 18F-FDG PET(/CT) in patients with esophageal cancer who received neoadjuvant therapy and both baseline staging and restaging after neoadjuvant therapy with 18F-FDG PET(/CT) imaging. The primary outcome measure was the proportion of patients in whom distant interval metastases were detected by 18F-FDG PET(/CT) as confirmed by pathology or clinical follow-up (i.e. true positives). The secondary outcome measure was the proportion of patients in whom 18F-FDG PET(/CT) restaging was false positive for distant interval metastases (i.e. false positives). Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Random-effect models were used to estimate pooled outcomes and examine potential sources of heterogeneity. Fourteen studies were included comprising a total of 1,110 patients who received baseline staging with 18F-FDG PET(/CT) imaging of whom 1,001 (90%) underwent restaging with 18F-FDG PET(/CT) imaging. Studies were generally of moderate quality. The pooled proportion of patients in whom true distant interval metastases were detected by 18F-FDG PET(/CT) restaging was 8% (95% confidence interval [CI]: 5-13%). The pooled proportion of patients in whom false positive distant findings were detected by 18F-FDG PET(/CT) restaging was 5% (95% CI: 3-9%). In conclusion,18F-FDG PET(/CT) restaging after neoadjuvant therapy for esophageal cancer detects true distant interval metastases in 8% of patients. Therefore, 18F-FDG PET(/CT) restaging can considerably impact on treatment decision-making. However, false positive distant findings occur in 5% of patients at restaging with 18F-FDG PET(/CT), underlining the need for pathological confirmation of suspected lesions. SN - 1442-2050 UR - https://www.unboundmedicine.com/medline/citation/29917073/Detection_of_distant_interval_metastases_after_neoadjuvant_therapy_for_esophageal_cancer_with_18F_FDG_PET_/CT_:_a_systematic_review_and_meta_analysis_ L2 - https://academic.oup.com/dote/article-lookup/doi/10.1093/dote/doy055 DB - PRIME DP - Unbound Medicine ER -