Diagnostic performance of F-18 FDG PET/CT for prediction of KRAS mutation in colorectal cancer patients: a systematic review and meta-analysis

  • Seong-Jang KimEmail author
  • Kyoungjune Pak
  • Keunyoung Kim
Hollow Organ GI



The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the prediction of v-Ki-ras-2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in colorectal cancer (CRC) patients through a systematic review and meta-analysis.


The PubMed and EMBASE database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for prediction of KRAS mutation in CRC patients.


Across 9 studies (804 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.66 (95% CI 0.60–0.73) without heterogeneity (I2 = 34.1, p = 0.14) and a pooled specificity of 0.67 (95% CI 0.62–0.72) without heterogeneity (I2 = 1.63, p = 0.42). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 2.0 (95% CI 1.7–2.4) and negative likelihood ratio (LR−) of 0.5 (95% CI 0.41–0.61). The pooled diagnostic odds ratio (DOR) was 4 (95% CI 3–6). Hierarchical summary receiver operating characteristic (ROC) curve indicates that the areas under the curve were 0.69 (95% CI 0.65–0.73).


The current meta-analysis showed the low sensitivity and specificity of F-18 FDG PET/CT for prediction of KRAS mutation in CRC patients. The DOR was very low and the likelihood ratio scatter-gram indicated that F-18 FDG PET/CT might not be useful for prediction of KRAS mutation and not for its exclusion. Therefore, cautious application and interpretation should be paid to the F-18 FDG PET/CT for prediction of KRAS mutation in CRC patients.


F-18 FDG Colon cancer Rectal cancer PET/CT KRAS 


Author contribution

Kim SJ and Pak K contributed in protocol/project development. Kim SJ, Kim K, and Pak K contributed in data collection or management. Kim SJ and Kim K contributed in data analysis. Kim SJ, Pak K, and Kim K contributed in manuscript writing/editing.

Funding information

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.

Ethical approval

Institutional review board approval was not required because we only performed data analysis based on the published studies.

Informed consent

Written informed consent was not required for this study because it is a meta-analysis based on the studies that have been published.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Seong-Jang Kim
    • 1
    • 2
    Email author
  • Kyoungjune Pak
    • 3
  • Keunyoung Kim
    • 3
  1. 1.Department of Nuclear Medicine, College of MedicinePusan National University Yangsan HospitalYangsanSouth Korea
  2. 2.BioMedical Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
  3. 3.Department of Nuclear MedicinePusan National University HospitalBusanSouth Korea

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