[18F]-FDG PET in anal canal cancer: a systematic review and meta-analysis

Seyed Ali Mirshahvalad; Aruz Mesci; Vanessa Murad; Andres Kohan; Claudia Ortega; Patrick Veit-Haibach; Ur Metser

doi:10.1007/s00259-023-06393-z

[¹⁸F]-FDG PET in anal canal cancer: a systematic review and meta-analysis

Eur J Nucl Med Mol Imaging. 2023 Dec;51(1):258-277. doi: 10.1007/s00259-023-06393-z. Epub 2023 Aug 18.

Authors

Seyed Ali Mirshahvalad^{1

2}, Aruz Mesci³, Vanessa Murad^{1

2}, Andres Kohan^{1

2}, Claudia Ortega^{1

2}, Patrick Veit-Haibach^{1

2}, Ur Metser^{4

5}

Affiliations

¹ Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada.
² Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada.
³ Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, ON, M5T 1P5, Canada.
⁴ Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada. ur.metser@uhn.ca.
⁵ Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada. ur.metser@uhn.ca.

PMID: 37592085
DOI: 10.1007/s00259-023-06393-z

Abstract

Purpose: To provide comprehensive data on the diagnostic and prognostic value of [¹⁸F]-FDG PET (PET) in anal canal cancer patients.

Methods: This study was designed following the PRISMA-DTA guidelines. For the meta-analysis, published original articles (until December 2022) that met the following criteria were included: Evaluated PET for locoregional and/or distant disease detection in patients with histopathology-proven anal canal cancer; Compared PET with a valid reference standard; Provided crude data to calculate meta-analytic estimates. Diagnostic measurements from subgroups were calculated in evaluating primary tumour detection, T stage, lymph node and distant metastases. Articles providing prognostic information on PET were also reported as a systematic review. For pooled meta-analytic calculations, the hierarchical method was used. The bivariate model was conducted to find the summary estimates. Analyses were performed using STATA 16.

Results: After the screening, 28 studies were eligible to enter the meta-analytic calculations, and data from 15 were reported descriptively. For distinguishing T3/T4 from other T-stages, PET had pooled sensitivity and specificity of 91%(95%CI:72%-97%) and 96%(95%CI:88%-98%), respectively. The sensitivity and specificity for detecting metastatic (regional and/or distant) disease were 100% (95%CI:82%-100%) and 95% (95%CI:90%-98%), respectively. For therapy response assessment, the sensitivity and specificity of PET were 96%(95%CI:78%-99%) and 86%(95%CI:75%-93%), respectively. Higher pre-treatment total metabolic tumour volume was predictive of poorer survival. Conversely, for those achieving complete metabolic response, the 2-year PFS was 94%(95%CI:91%-97%) versus 51%(95%CI:42%-59%) for others (p-value < 0.001).

Conclusion: PET may be a useful tool for anal canal cancer therapy planning and provides valuable prognostic information.

Keywords: Anal cancer; Fluorodeoxyglucose F18; Meta-analysis; PRISMA; Positron-emission tomography.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Anal Canal
Fluorodeoxyglucose F18*
Humans
Neoplasms*
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography / methods
Radiopharmaceuticals
Sensitivity and Specificity

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals

Supplementary concepts

Anal Canal Carcinoma