18F-FDG PET for evaluation of bone marrow infiltration in staging of lymphoma： a meta-analysis.pdf

18F-FDG PET for Evaluation of Bone Marrow Infiltration in Staging of Lymphoma: A Meta-Analysis Emilios E. Pakos, MD1; Andreas D. Fotopoulos, MD2; and John P.A. Ioannidis, MD1,3,4 1Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; 2Department of Nuclear Medicine, University Hospital of Ioannina, School of Medicine, Ioannina, Greece; 3Biomedical Research Institute, Foundation for Research and Technology–Hellas, Ioannina, Greece; and 4Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts–New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts The ability of PET with 18F-FDG to evaluate bone marrow infil- tration in patients with lymphoma has been a matter of exten- sive investigation with controversial results. Therefore, we aimed to evaluate systematically, with a meta-analysis, the di- agnostic performance of 18F-FDG PET in this setting. Methods: Relevant studies were identified with MEDLINE and EMBASE searches (last update, August 2004). Data on the diagnostic performance of 18F-FDG PET were combined quantitatively across eligible studies. We estimated weighted summary sen- sitivities and specificities, summary receiver-operating-charac- teristic (SROC) curves, and weighted summary likelihood ratios. We also conducted separate analyses according to various subgroups. Bone marrow biopsy (BMB) was used as the refer- ence standard. Results: Thirteen eligible nonoverlapping stud- ies, which enrolled a total of 587 patients, were included in the meta-analysis. The independent random-effects weighted esti- mates of sensitivity and specificity against BMB were 51% (95% confidence interval [CI], 38%–64%) and 91% (95% CI, 85%–95%), respectively. Results were consistent in the SROC curve: a sensitivity of 51% corresponds to a specificity of 92%, whereas a specificity of 91% corresponds to a sensitivity of 55%. The weigh