Jo I, Gould D, Schlicht S, Taubman K, Choong P. Diagnostic accuracy of functional imaging modalities for chondrosarcoma: A systematic review and meta-analysis.
J Bone Oncol 2019;
19:100262. [PMID:
31667063 PMCID:
PMC6811998 DOI:
10.1016/j.jbo.2019.100262]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/03/2022] Open
Abstract
Functional imaging modalities may have an important role in diagnosing chondrosarcomas.
PET is a sensitive and specific test for differentiating chondrosarcomas and benign chondroid tumours.
Thallium-201 scintigraphy has a high positive predictive value for chondrosarcomas.
DMSA (V) has a 100% negative predictive value and can be used to rule out chondrosarcomas.
Introduction
The distinction between low-grade (grade 1) chondrosarcoma and its benign counterparts can be challenging. This systematic review aims to quantify the diagnostic accuracies of all functional imaging modalities used in the diagnosis of chondrosarcoma.
Methods
Medline and Embase were searched in February 2019. We included studies of either retrospective or prospective design if the results of functional scans were compared with pre-determined reference standards. Studies had to be primary diagnostic reports on patients with chondral tumours at first diagnosis. Two review authors independently performed study selection, extracted data and assessed the methodological quality. We calculated diagnostic accuracy measures for each included study.
Results
Four functional imaging modalities were identified across thirteen studies that met the inclusion criteria. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) was a sensitive and specific test. Technetium-99 m with methylene diphosphonate (Tc-99 m MDP) had an overall low specificity of 4%. Thallium-201 scintigraphy demonstrated high positive predictive values across the studies. The negative predictive values of Technetium-99 m pentavalent dimercaptosuccinic acid (Tc-99 m DMSA (V)) were consistently 100%.
Conclusions
Low-grade chondrosarcomas continue to pose a diagnostic dilemma. FDG-PET demonstrated superior diagnostic accuracy compared to Tc-99 m MDP, Thallium-201 and Tc-99 m DMSA (V). Characteristic uptake patterns of Thallium-201 and Tc-99 m DMSA (V) may provide additional metabolic information to guide the diagnosis in this challenging group of tumours.
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