Diagnostic performance of choline PET/CT for the detection of bone metastasis in prostate cancer: A systematic review and meta-analysis

Purpose The aim of this study was to evaluate the diagnostic performance of choline positron emission tomography/computed tomography (PET/CT) for the detection of bone metastasis in patients with prostate cancer. Methods MEDLINE, EMBASE and the Cochrane Library were searched up to 20 February 2018 for studies that used 11C-choline or 18F-choline PET/CT for the detection of bone metastasis in patients with prostate cancer and "histopathology and/or clinical follow-up" as the reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled diagnostic accuracy with the 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed hierarchical summary receiver operating characteristic curves and performed meta-regression analyses. Results Fourteen studies with reasonable methodological quality were included in the analysis. On a per-patient basis, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.89 (95% CI 0.80-0.94), 0.98 (95% CI 0.95-0.99), 40.4 (95% CI 19.7-82.6), 0.12 (95% CI 0.07-0.20), and 344 (95% CI 148-803), respectively. On a per-lesion basis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.91 (95% CI 0.85-0.94), 0.97 (95% CI 0.95-0.98), 34.1 (95% CI 20.0-58.1), 0.10 (95% CI 0.06-0.16), and 358 (95% CI 165-778), respectively. In the meta-regression analysis, the clinical setting (staging vs. restaging) was the only source of study heterogeneity on a per-patient basis. Conclusions Choline PET/CT shows excellent diagnostic performance for the detection of bone metastasis. However, a negative choline PET/CT result cannot ensure the lack of bone metastasis.