Diagnostic performance of F-18 FDG PET/CT for prediction of KRAS mutation in colorectal cancer patients: a systematic review and meta-analysis
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.
KeywordsF-18 FDG Colon cancer Rectal cancer PET/CT KRAS
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.
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.
Institutional review board approval was not required because we only performed data analysis based on the published studies.
Written informed consent was not required for this study because it is a meta-analysis based on the studies that have been published.
- 3.Eberhard DA, Johnson BE, Amler LC, et al. (2005) Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol 23(25):5900–5909CrossRefGoogle Scholar
- 10.Czernin J, Allen-Auerbach M, Schelbert HR (2007) Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med 48(Suppl 1):78S–88SGoogle Scholar
- 11.Bar-Shalom R, Yefremov N, Guralnik L, et al. (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 44(8):1200–1209Google Scholar
- 15.Oner AO, Budak ES, Yıldırım S, Aydın F, Sezer C (2017) The value of 18FDG PET/CT parameters, hematological parameters and tumor markers in predicting KRAS oncogene mutation in colorectal cancer. Hell J Nucl Med 20(2):160-165Google Scholar
- 27.Chen SW, Shen WC, Chen WT, et al. (2018) Metabolic Imaging Phenotype Using Radiomics of [18F]FDG PET/CT Associated with Genetic Alterations of Colorectal Cancer. Mol Imaging Biol 2018 Jun 12. https://doi.org/10.1007/s11307-018-1225-8. [Epub ahead of print]
- 31.Krikelis D, Skoura E, Kotoula V, et al. (2014) Lack of association between KRAS mutations and 18F-FDG PET/CT in Caucasian metastatic colorectal cancer patients. Anticancer Res 34(5):2571–2579Google Scholar
- 34.Mao W, Zhou J, Zhang H, et al. (2018) Relationship between KRAS mutations and dual time point 18F-FDG PET/CT imaging in colorectal liver metastases. Abdom Radiol (NY) 2018 Aug 24. https://doi.org/10.1007/s00261-018-1740-8. [Epub ahead of print]
- 35.Forrester K, Almoguera C, Han K, Grizzle WE, Perucho M (1987) Detection of high incidence of K-ras oncogenes during human colon tumorigenesis. Nature 327(6120):298–303Google Scholar