FDG PET-CT vs. CT for Recurrence in Post-treatment Pancreatic Adenocarcinoma (PAC): Comparative Diagnostic Test Accuracy Systematic Review and Meta-analysis.

Objectives: To perform a systematic review comparing diagnostic test accuracy of FDG PET-CT versus CT for assessing recurrence in post-treatment pancreatic adenocarcinoma (PAC).

Methods: Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science searched until February 2024 for comparative diagnostic accuracy studies assessing PET-CT versus CT in post-treated subjects with PAC to evaluate diagnostic accuracy for recurrence. The reference standard was histopathology when available or clinical follow-up. Data extraction, risk of bias (ROB), and applicability assessment were performed by two authors. QUADAS-C was used for ROB assessment. Bivariate random-effects model meta-analysis, and meta-regression were performed for test comparison with 95% confidence intervals (95%CI).

Results: Of 5345 citations retrieved, nine articles met all inclusion criteria, with 400 PAC patients who had 320 recurrences included. Three studies were considered at low risk of bias, while the remaining six studies were at high risk for bias. The sensitivity/specificity (95%CI) and AUC of PET-CT was 89% (83-92%)/83% (73-90%) and 0.927 and for CT was 72% (64-79%)/76% (64-85%) and 0.803. A meta-regression model demonstrated a higher sensitivity for PET-CT than CT alone (P<0.001), with no significant difference in specificity (P=0.243). Risk of bias had no significant impact on CT or PET-CT diagnostic accuracy (P=0.072-0.775).

Conclusions: PET-CT exhibited greater sensitivity compared to CT alone, with no significant variance in specificity between the two modalities, for recurrence evaluation in PAC.