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The Role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this systematic review and meta-analysis was to compare the role of FDG-positron emission tomography (PET) or PET/computed tomography (CT) with conventional imaging in the detection of primary and nodal disease in anal cancer, and to assess the impact of PET or PET/CT on the management of anal cancer.

Methods

A systematic review of the literature was performed. Eligible studies included those comparing PET or PET/CT with conventional imaging in the staging of histologically confirmed anal squamous cell carcinoma (SCC), or studies that performed PET or PET/CT imaging to assess response following treatment.

Results

Twelve studies met the inclusion criteria. For the detection of primary disease, CT and PET had a sensitivity of 60 % (95 % confidence interval [CI] 45.5–75.2) and 99 % (95 % CI 96–100), respectively. Compared with conventional imaging, PET upstaged 15 % (95 % CI 10–21) and downstaged 15 % (95 % CI 10–20) of nodal disease. This led to a change in nodal staging in 28 % of patients (95 % CI 18–38). When only studies performing contemporary PET/CT were considered, the rate of nodal upstaging was 21 % (95 % CI 13–30) and the TNM stage was altered in 41 % of patients. Following chemoradiotherapy, 78 % (95 % CI 65–88) of patients had a complete response on PET.

Conclusion

Compared with conventional imaging, PET or PET/CT alters the nodal status in a sufficient number of cases to justify its routine use in the staging of patients with anal SCC.

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Acknowledgment

The authors thank Dr. Christopher Oldmeadow for performing the statistical analysis.

Disclosures

None.

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Authors and Affiliations

  1. Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, Australia

    Michael Jones BSc, BE (Hons), MBBS, MPHTM & George Hruby BHB, MBChB, FRANZCR

  2. Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia

    Michael Solomon MBBCh, BAO (Hons), MSc, LRCPI, FRACS, FRCSI (Hon)

  3. Department of Nuclear Medicine, Calvary Mater Newcastle, Waratah, Australia

    Natalie Rutherford BMed, BMedSci, FRACP

  4. Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Australia

    Jarad Martin BSc, MBChB, DMed (Research), FRANZCR, GAustMS

Authors
  1. Michael Jones BSc, BE (Hons), MBBS, MPHTM
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  2. George Hruby BHB, MBChB, FRANZCR
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  3. Michael Solomon MBBCh, BAO (Hons), MSc, LRCPI, FRACS, FRCSI (Hon)
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  4. Natalie Rutherford BMed, BMedSci, FRACP
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  5. Jarad Martin BSc, MBChB, DMed (Research), FRANZCR, GAustMS
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Correspondence to Michael Jones BSc, BE (Hons), MBBS, MPHTM.

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Jones, M., Hruby, G., Solomon, M. et al. The Role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 22, 3574–3581 (2015). https://doi.org/10.1245/s10434-015-4391-9

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  • DOI: https://doi.org/10.1245/s10434-015-4391-9

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