Diagnostic accuracy of C-11 choline and C-11 acetate for lymph node staging in patients with bladder cancer: a systematic review and meta-analysis

Objective We aimed to assess the diagnostic accuracy of C-11 choline and C-11 acetate positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging in bladder cancer (BC) patients through a systematic review and meta-analysis. Methods The MEDLINE, EMBASE, and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of C-11 choline and C-11 acetate PET/CT for LN staging in BC. 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 10 studies (282 patients), the pooled sensitivity was 0.66 (95% CI 0.54–0.75) without heterogeneity ( χ 2 = 12.4, p = 0.19) and a pooled specificity of 0.89 (95% CI 0.76–0.95) with heterogeneity ( χ 2 = 29.1, p = 0.00). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 5.8 (95% CI 2.7–12.7) and negative likelihood ratio (LR−) of 0.39 (95% CI 0.28–0.53). The pooled diagnostic odds ratio (DOR) was 15 (95% CI 6–38). In meta-regression analysis, the study design (prospective vs retrospective) was the source of the study heterogeneity. Conclusion C-11 choline and C-11 acetate PET/CT shows a low sensitivity and moderate specificity for the detection of metastatic LNs in patients with BC. Moreover, heterogeneity among the studies should be considered a limitation. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of C-11 choline and C-11 acetate PET/CT for this purpose.