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Diagnostic accuracy of C-11 choline and C-11 acetate for lymph node staging in patients with bladder cancer: a systematic review and meta-analysis

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Abstract

Objective

We aimed to assess the diagnostic accuracy of C-11 choline and C-11 acetate positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging in bladder cancer (BC) patients through a systematic review and meta-analysis.

Methods

The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of C-11 choline and C-11 acetate PET/CT for LN staging in BC. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves.

Results

Across 10 studies (282 patients), the pooled sensitivity was 0.66 (95% CI 0.54–0.75) without heterogeneity (χ2 = 12.4, p = 0.19) and a pooled specificity of 0.89 (95% CI 0.76–0.95) with heterogeneity (χ2 = 29.1, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.8 (95% CI 2.7–12.7) and negative likelihood ratio (LR−) of 0.39 (95% CI 0.28–0.53). The pooled diagnostic odds ratio (DOR) was 15 (95% CI 6–38). In meta-regression analysis, the study design (prospective vs retrospective) was the source of the study heterogeneity.

Conclusion

C-11 choline and C-11 acetate PET/CT shows a low sensitivity and moderate specificity for the detection of metastatic LNs in patients with BC. Moreover, heterogeneity among the studies should be considered a limitation. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of C-11 choline and C-11 acetate PET/CT for this purpose.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea

    Seong-Jang Kim

  2. BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea

    Seong-Jang Kim

  3. Diagnostic Imaging, Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Drive, Gilbert, AZ, 85234, USA

    Phillip J. Koo

  4. Department of Nuclear Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea

    Kyoungjune Pak, In-Ju Kim & Keunyoung Kim

Authors
  1. Seong-Jang Kim
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  2. Phillip J. Koo
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  3. Kyoungjune Pak
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  4. In-Ju Kim
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  5. Keunyoung Kim
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Contributions

Protocol/project development: KSJ. Data collection or management: KSJ and PJK. Data analysis: KSJ and PJK. Manuscript writing/editing; KSJ and PJK.

Corresponding author

Correspondence to Seong-Jang Kim.

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Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional review board approval was not required because we only performed data analysis based on the published studies.

Informed consent

Written informed consent was not required for this study because it is a meta-analysis based on the studies that have been published.

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Kim, SJ., Koo, P.J., Pak, K. et al. Diagnostic accuracy of C-11 choline and C-11 acetate for lymph node staging in patients with bladder cancer: a systematic review and meta-analysis. World J Urol 36, 331–340 (2018). https://doi.org/10.1007/s00345-017-2168-4

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  • DOI: https://doi.org/10.1007/s00345-017-2168-4

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