18F-FDG PET and PET/CT as a diagnostic method for Ewing sarcoma: A systematic review and meta-analysis

Purpose The aim of this study was to evaluate the diagnostic accuracy of (18)-fluorodeoxyglucose-positron emission tomography (F-18-FDG PET) and PET/computed tomography (PET/CT) in imaging primary and metastatic lesions in Ewing sarcoma (ES). Methods PubMed, Cochrane, Scopus, and Web of Science were searched for relevant studies. Data concerning F-18-FDG PET/CT diagnostic accuracy were extracted and then analyzed using Open Meta-analyst software. Reported diagnostic accuracy outcomes included sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), and diagnostic odds ratio. Results Thirty-one studies with a total of 735 patients were included in this meta-analysis. The sensitivity and specificity of F-18-FDG PET/CT were: 92.6% and 74.1% for total ES lesions, 96.7% and 68.3% for ES primary lesions, 76.1% and 92.4% for lung metastasis, 83.9% and 93.2% for bone metastasis, and 89.9% and 92.6% for ES recurrence, respectively. Conclusion F-18-FDG PET/CT is sensitive and accurate in diagnosing, staging, and detecting the recurrence of ES compared with non-PET imaging. It has high accuracy for diagnosing recurrence of ES in bone metastases; however, CT remains a superior diagnostic method for detecting lung metastasis.