Diagnostic accuracy of 18F flucholine PET/CT for preoperative lymph node staging in newly diagnosed prostate cancer patients; a systematic review and meta-analysis

Objectives: The purpose of the current study was to investiagte the diagnostic accuracy of 18F flucholine (FCH) positron emission tomography/CT (PET/CT) for pre-operative lymph node (LN) staging in newly diagnosed prostate cancer (PCa) patients using meta-analysis. Methods: PubMed and Embase from the earliest available date of indexing through December 31, 2018, were searched for studies evaluating the diagnostic performance of 18F FCH PET/CT for preoperative LN staging in newly diagnosed PCa. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR-), and constructed summary receiver operating characteristic curves. Results: Across seven studies (627 patients), the pooled sensitivity was 0.57 [95% confidence interval (CI) (0.42–0.70)] and a pooled specificity of 0.94 [95% CI (0.89–0.97)]. Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 10.2 (95% CI; 5.0–21.0) and negative likelihood ratio (LR-) of 0.46 (95% CI; 0.33–0.64). The pooled diagnostic odds ratio was 22 (95% CI; 9–54). Conclusions: 18F FCH PET/CT shows a low sensitivity and high specificity for the detection of metastatic LNs in patients with newly diagnosed PCa. Also, 18F FCH PET/CT is only useful for confirmation of LN metastasis (when positive) in PCa patients. Advances in knowledge: 18F FCH PET/CT demonstrates low sensitivity but high specificity for diagnosis of metastatic LNs in patients with newly diagnosed PCa. Also, 18F FCH PET/CT is only useful for confirmation of LN metastasis (when positive) in PCa patients.