An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review.
An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review.
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DOI：
10.1136/bmjopen-2014-006030
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发表时间：
2015-01-08
期刊：
影响因子：
2.9
通讯作者：
Phillips B
中科院分区：
文献类型：
--
作者：
Norman G;Fayter D;Lewis-Light K;Chisholm J;McHugh K;Levine D;Jenney M;Mandeville H;Gatz S;Phillips B
横纹肌肉瘤 (RMS) 的管理取决于诊断和治疗反应时的风险分层。评估方法包括CT、MRI、骨闪烁扫描、组织学分析和骨髓活检。高级功能成像 (FI) 有潜力提高分期准确性和管理策略。我们对 FI 在经组织学证明的儿科 RMS 中的诊断准确性和临床有效性进行了系统评价 (PROSPERO 2013:CRD42013006128)。遵循 PRISMA 指南。截至 2013 年 11 月，我们检索了 10 个数据库。纳入了≥10 名 RMS 患者的研究，这些研究在任何治疗阶段将正电子发射断层扫描 (PET)、PET-CT 或扩散加权成像 (DWI) MRI 与传统成像进行比较。评估了研究质量。有限的、异质的有效性数据需要叙述性综合，通过在受试者工作曲线 (ROC) 空间中绘制敏感性和特异性来说明。共纳入 8 项研究（6 项 PET-CT，2 项 PET），涉及 272 名 RMS 患者。没有 DWI-MRI 研究符合纳入标准。由于数据稀疏，未计算汇总估计值。有限的证据表明最初的 PET-CT 结果可以预测生存。 PET-CT 改变了 7/40 患者的治疗。淋巴结受累PET-CT：敏感性80%～100%；特异性从 89% 到 100%。远处转移受累：PET-CT敏感性范围为95%至100%；特异性从80%到100%。有关不同部位转移的数据很少。通过 PET-CT 反应预测结果的数据有限。 PET/PET-CT 可能会提高儿童 RMS 的初始分期准确性，特别是在淋巴结受累和远处转移扩散的检测方面。有必要进一步评估该人群的 PET-CT，最好是在具有代表性、公正且透明选择的患者队列中进行评估。
Rhabdomyosarcoma (RMS) management depends on risk stratification at diagnosis and treatment response. Assessment methods include CT, MRI, bone scintigraphy, histological analysis and bone marrow biopsy. Advanced functional imaging (FI) has potential to improve staging accuracy and management strategies. We conducted a systematic review (PROSPERO 2013:CRD42013006128) of diagnostic accuracy and clinical effectiveness of FI in histologically proven paediatric RMS. PRISMA guidance was followed. We searched 10 databases to November 2013. Studies with ≥10 patients with RMS which compared positron emission tomography (PET), PET-CT or diffusion-weighted imaging (DWI) MRI to conventional imaging at any treatment stage were included. Study quality was assessed. Limited, heterogeneous effectiveness data required narrative synthesis, illustrated by plotting sensitivity and specificity in receiver operating curve (ROC) space. Eight studies (six PET-CT, two PET) with 272 RMS patients in total were included. No DWI-MRI studies met inclusion criteria. Pooled estimates were not calculated due to sparseness of data. Limited evidence indicated initial PET-CT results were predictive of survival. PET-CT changed management of 7/40 patients. Nodal involvement PET-CT: sensitivity ranged from 80% to 100%; specificity from 89% to 100%. Distant metastatic involvement: PET-CT sensitivity ranged from 95% to 100%; specificity from 80% to100%. Data on metastases in different sites were sparse. Limited data were found on outcome prediction by PET-CT response. PET/PET-CT may increase initial staging accuracy in paediatric RMS, specifically in the detection of nodal involvement and distant metastatic spread. There is a need to further assess PET-CT for this population, ideally in a representative, unbiased and transparently selected cohort of patients.
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