Diagnostic Performance of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography Imaging in Uterine Sarcomas Systematic Review and Meta-Analysis of the Literature

Objective: We reviewed the medical literature on the application of fluorine-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) imaging in the management of uterine sarcomas and presented the results in systematic review and meta-analysis format. Methods: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "PETAND (Uterine OR Uterus)" as key words. All studies evaluating the accuracy of F-18-FDG imaging in the staging or restaging of uterine sarcomas were included if enough data could be extracted for calculation of sensitivity and/or specificity. Results: Eight studies were included in the systematic review. Only 2 studies reported the accuracy of F-18-FDG PET imaging in the primary staging of uterine sarcoma with low sensitivity for lymph node staging. For restaging (detection of recurrence), all 8 included studies had quantitative data, and the patient-based pooled sensitivity and specificity were 92.1% (95% confidence interval [95% CI], 82.4-97.4) and 96.2% (95% CI, 87-99.5), respectively. On a lesion-based analysis, sensitivity was 86.3% (95% CI, 76.7-92.9), and specificity was 94.4% (95% CI, 72.7-99.9). Device used (PET vs PET/CT), spectrum of studied patients, and histology of the sarcoma seem to be factors influencing the overall accuracy of F-18-FDG PET imaging. Conclusions: (8)Fluorine-18-fluorodeoxyglucose PET and PET/CT seem to be accurate methods for detection and localization of recurrence in patients with uterine sarcoma. Further large multicenter studies are needed to validate our results and to correlate both sarcoma type and spectrum of patients to the diagnostic performance of F-18-FDG PET imaging in recurrence detection. The studies evaluating the accuracy of F-18-FDG PET imaging for the primary staging of uterine sarcoma are very limited, and no definite conclusion can be made in this regard.