Applicability and performance of ¹⁸F-FDG PET-based modalities for whole-body cancer screening: a systematic review...

Screening tests are the cornerstone for early detection and optimal management of cancers. Most of the present cancer-screening tests are intrusive, time-consuming, and specifically target a particular anatomical site or cancer type. Only a few studies have reported the objective measures of ¹⁸F-FDG PET-based cancer screening in asymptomatic individuals. This review and meta-analysis is an attempt to assess the applicability and performance of ¹⁸F-FDG PET-based modalities for whole-body cancer screening.

The systematic review and meta-analysis were performed following PRISMA guidelines. Literature searches in PubMed, Scopus, and Embase were conducted using relevant MeSH terms and keywords, for articles published in the last 2 decades (2000-2022). Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and hierarchical summary ROC (HSROC) curve were generated using bivariate random-effects meta-analysis.

Seventeen studies were included in the systematic review and 13 studies were deemed eligible for meta-analysis. The mean estimates of pooled sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and Odds ratio using ¹⁸F-FDG PET with a 95% confidence interval were 0.47 (0.25-0.69), 0.97 (0.95-0.98), 18.8 (6.8-51.5), 0.45 (0.27-0.76), 41.0 (7.9-211.8) and for ¹⁸F-FDG PET/CT were 0.83 (0.75-0.88), 0.98 (0.97-0.99), 49.7 (29.2-84.5), 0.15 (0.8-0.28), 329.9 (125.0-870.8), respectively. Among screening modalities, ¹⁸F-FDG PET/CT had a higher accuracy i.e., the area under the HSROC curve (AUC): 0.91 (0.87-0.95) compared to ¹⁸F-FDG PET: 0.72 (0.61-0.82).

This study demonstrates that currently ¹⁸F-FDG PET-based screening has limited applicability for population-based cancer-screening programs. However, it has a promising role as a combined screening strategy for at-risk individuals and allows for comprehensive diagnostic and prognostic evaluation in high-resource settings.