BACKGROUND: Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP. MATERIALS AND METHODS: Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity. RESULTS: Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%-40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% [95% CI 18-28%]) than detection of additional metastatic sites (14% [95% CI 10-19%]). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%-38.2%). CONCLUSION: FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
BACKGROUND: Cancers of unknown primary (CUP) have traditionally been treated empirically, with a dismal prognosis. Compared with standard diagnostic tests, including CT and MRI, imaging with 18F-fluorodeoxyglucose (FDG) PET or PET/CT has shown the capacity to better identify the primary tumour site and detect additional sites of metastasis. However, its clinical impact is not well established. We performed a systematic review and meta-analysis of prior studies to assess the impact of FDG-PET or PET/CT on the management of patients with CUP. MATERIALS AND METHODS: Pubmed and EMBASE databases were searched up to 4th February 2021. Studies that reported the proportion of patients with CUP who experienced a management change after FDG-PET or PET/ computed tomography (CT) were included and the proportions were pooled using the random-effects model. Study quality was assessed using QUADAS-2. Subgroup analysis was conducted to explore heterogeneity. RESULTS: Thirty-eight studies (involving 2795 patients) were included. The pooled proportion of patients with management changes was 35% (95% confidence interval 31%-40%). There was substantial heterogeneity among the studies (Q-test, p < 0.01; I2 = 82%). The specific reason for management change was more commonly detection of the primary site (22% [95% CI 18-28%]) than detection of additional metastatic sites (14% [95% CI 10-19%]). The pooled proportions of patients with management changes were similar among numerous subgroups (range, 32.8%-38.2%). CONCLUSION: FDG-PET or PET/CT had a meaningful impact on the management of patients with CUP. Approximately, a third of patients had their management changed because of FDG-PET or PET/CT results, and this finding was consistent across numerous subgroups.
Authors: Matthew D F McInnes; David Moher; Brett D Thombs; Trevor A McGrath; Patrick M Bossuyt; Tammy Clifford; Jérémie F Cohen; Jonathan J Deeks; Constantine Gatsonis; Lotty Hooft; Harriet A Hunt; Christopher J Hyde; Daniël A Korevaar; Mariska M G Leeflang; Petra Macaskill; Johannes B Reitsma; Rachel Rodin; Anne W S Rutjes; Jean-Paul Salameh; Adrienne Stevens; Yemisi Takwoingi; Marcello Tonelli; Laura Weeks; Penny Whiting; Brian H Willis Journal: JAMA Date: 2018-01-23 Impact factor: 56.272
Authors: Verena Ruhlmann; Marcus Ruhlmann; Alexander Bellendorf; Johannes Grueneisen; Lino M Sawicki; Hong Grafe; Michael Forsting; Andreas Bockisch; Lale Umutlu Journal: Eur J Radiol Date: 2016-08-31 Impact factor: 3.528
Authors: Christian Philipp Reinert; Julia Sekler; Christian la Fougère; Christina Pfannenberg; Sergios Gatidis Journal: Eur Radiol Date: 2019-11-14 Impact factor: 5.315
Authors: E Briasoulis; H Kalofonos; D Bafaloukos; E Samantas; G Fountzilas; N Xiros; D Skarlos; C Christodoulou; P Kosmidis; N Pavlidis Journal: J Clin Oncol Date: 2000-09 Impact factor: 44.544