Identifying the primary tumour in patients with cancer of unknown primary (CUP) using [18F]FDG PET/CT: a systematic review and individual patient data meta-analysis,European Journal of Nuclear Medicine and Molecular Imaging

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Identifying the primary tumour in patients with cancer of unknown primary (CUP) using [18F]FDG PET/CT: a systematic review and individual patient data meta-analysis
European Journal of Nuclear Medicine and Molecular Imaging ( IF 8.6 ) Pub Date : 2024-08-14 , DOI: 10.1007/s00259-024-06860-1
Jeroen R J Willemse _{1,

2} , Doenja M J Lambregts _{1,

2} , Sara Balduzzi ₃ , Winnie Schats ₄ , Petur Snaebjornsson _{5,

6} , Serena Marchetti ₇ , Marieke A Vollebergh ₈ , Larissa W van Golen ₉ , Zing Cheung ₉ , Wouter V Vogel _{9,

10} , Zuhir Bodalal _{1,

2} , Sajjad Rostami _{1,

2} , Oke Gerke _{11,

12} , Tharani Sivakumaran _{13,

14} , Regina G H Beets-Tan _{1,

2,

15} , Max J Lahaye _{1,

2}

Affiliation

Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands.
GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands.
Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Scientific Information Service, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Medical Oncology and Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne VIC, Melbourne, VIC, Australia.
Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.

Purpose

In this systematic review and individual patient data (IPD) meta-analysis, we analysed the diagnostic performance of [¹⁸F]FDG PET/CT in detecting primary tumours in patients with CUP and evaluated whether the location of the predominant metastatic site influences the diagnostic performance.

Methods

A systematic literature search from January 2005 to February 2024 was performed to identify articles describing the diagnostic performance of [¹⁸F]FDG PET/CT for primary tumour detection in CUP. Individual patient data retrieved from original articles or obtained from corresponding authors were grouped by the predominant metastatic site. The diagnostic performance of [¹⁸F]FDG PET/CT in detecting the underlying primary tumour was compared between predominant metastatic sites.

Results

A total of 1865 patients from 32 studies were included. The largest subgroup included patients with predominant bone metastases (n = 622), followed by liver (n = 369), lymph node (n = 358), brain (n = 316), peritoneal (n = 70), lung (n = 67), and soft tissue (n = 23) metastases, leaving a small group of other/undefined metastases (n = 40). [¹⁸F]FDG PET/CT resulted in pooled detection rates to identify the primary tumour of 0.74 (for patients with predominant brain metastases), 0.54 (liver-predominant), 0.49 (bone-predominant), 0.46 (lung-predominant), 0.38 (peritoneal-predominant), 0.37 (lymph node-predominant), and 0.35 (soft-tissue-predominant).

Conclusion

This individual patient data meta-analysis suggests that the ability of [¹⁸F]FDG PET/CT to identify the primary tumour in CUP depends on the distribution of metastatic sites. This finding emphasises the need for more tailored diagnostic approaches in different patient populations. In addition, alternative diagnostic tools, such as new PET tracers or whole-body (PET/)MRI, should be investigated.

中文翻译：

使用 [18F]FDG PET/CT 识别原发不明癌症 (CUP) 患者的原发肿瘤：系统评价和个体患者数据荟萃分析

目的

在这项系统回顾和个体患者数据（IPD）荟萃分析中，我们分析了 [ ¹⁸ F]FDG PET/CT 在检测 CUP 患者原发肿瘤方面的诊断性能，并评估了主要转移部位的位置是否影响诊断表现。

方法

我们对 2005 年 1 月至 2024 年 2 月进行了系统文献检索，以识别描述 [ ¹⁸ F]FDG PET/CT 对 CUP 原发肿瘤检测的诊断性能的文章。从原始文章中检索或从相应作者处获得的个体患者数据按主要转移部位进行分组。比较了[ ¹⁸ F]FDG PET/CT 在检测主要转移部位之间的潜在原发肿瘤的诊断性能。

结果

共有来自 32 项研究的 1865 名患者被纳入。最大的亚组包括骨转移为主的患者 ( n = 622)，其次是肝脏 ( n = 369)、淋巴结 ( n = 358)、脑 ( n = 316)、腹膜 ( n = 70)、肺 ( n = 67）和软组织（ n = 23）转移，留下一小部分其他/未定义的转移（ n = 40）。 [ ¹⁸ F]FDG PET/CT 确定原发肿瘤的汇总检出率为 0.74（脑转移为主的患者）、0.54（肝脏为主）、0.49（骨为主）、0.46（肺为主）、 0.38（腹膜为主）、0.37（淋巴结为主）和0.35（软组织为主）。