Impact of 18-FDG PET/CT on Multidisciplinary Decision-Making and Management in Abdominal Malignancies: A Systematic Review and Meta-Analysis.

Abstract

Purpose: To systematically review and assess the impact of 18 F-FDG PET/CT on multidisciplinary team (MDT) decision-making and management in adults with abdominal malignancies.

Materials & methods: We searched Ovid MEDLINE, Ovid Epub, Cochrane CENTRAL, EMBASE, and Scopus upto August 31, 2024, for studies including 18-FDG PET/CT and MDT management in abdominal malignancies in adult patients and describing pre- and post-PET/CT treatment plans or MDT decisions. Data extraction followed by independent two reviewer assessment using ROBINS-I framework. A random-effects meta-analysis of proportions was performed for studies reporting management change attributable to PET/CT.

Results: Fourteen studies met inclusion criteria, of which seven provided sufficient quantitative data for meta-analysis. A random-effects meta-analysis of the seven eligible quantitative studies showed that 21.8% of patients (95% CI: 10.6%-33.0%, p < 0.001; range: 8-36%) experienced a management change directly attributable to PET-based imaging. Between-study heterogeneity was substantial (I² ≈ 85%, p < 0.001). Reported management changes included cancellation or addition of planned surgery, modification of surgical extent, change in treatment intent between curative and palliative strategies, and alteration of systemic therapy or radiotherapy plans. Evidence on downstream outcomes such as survival, quality of life, and cost-effectiveness was limited and heterogeneous, precluding quantitative synthesis.

Conclusion: PET/CT leads to a change in MDT management in roughly one in five patients with abdominal malignancies, often through re-staging and identification of occult metastases that alter treatment intent or surgical strategy. The magnitude of impact varies widely by clinical context and tumor type.