Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children74410.24287/1726-1708-2023-22-4-158-169LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫThe diagnostic roles of fused 18F-fluorodeoxyglucose positron emission tomography/computed tomography and bone scintigraphy in children and young adults with bone sarcomas: a systematic review and meta-analysisДиагностическая роль позитронно-эмиссионной томографии, совмещенной с компьютерной томографией, с 18F-фтордезоксиглюкозой и сцинтиграфии костей скелета у детей и молодых взрослых с костными саркомами: систематический обзор и метаанализhttps://orcid.org/0000-0003-3792-16829654-6750YadgarovM. Ya.ЯдгаровМ. Я.
Russian Federation

Mikhail Ya. Yadgarov, MD, Cand. Med. Sci., a cyberneticist at the PET and Radionuclide Diagnosis Department

1 Samory Mashela St., 117997, Moscow

Ядгаров Михаил Яковлевич, канд. мед наук, врач-кибернетик отделения позитронно-эмиссионной томографии и радионуклидной диагностики

117997, Москва, ул. Саморы Машела, 1

mikhail.yadgarov@mail.ruhttps://orcid.org/0000-0003-3990-8879KireevaE. D.КирееваЕ. Д.
Russian Federation

Moscow

Москва

elena.kireeva@fccho-moscow.ruhttps://orcid.org/0000-0002-7427-4560Kailash.Кайлаш.
Russian Federation

Moscow

Москва

kailash@fccho-moscow.ruhttps://orcid.org/0000-0001-9830-5686DunaikinM. M.ДунайкинМ. М.
Russian Federation

Moscow

Москва

maksim.dunaykin@fccho-moscow.ruhttps://orcid.org/0000-0002-6158-2222LikarYu. N.ЛикарьЮ. Н.
Russian Federation

Moscow

Москва

Yury.Likar@fccho-moscow.ruDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian FederationФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России201220232241581692306202311072023Copyright ©; 2023, «D. Rogachev NMRCPHOI»Copyright ©; 2023, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2023«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/744

Osteosarcoma and Ewing sarcoma are the most common primary malignant bone diseases in children. An accurate diagnosis and staging of these tumors play a pivotal role in choosing the optimal treatment and predicting outcomes. In recent years, fused 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been increasingly used in the diagnosis of bone sarcomas. It is frequently applied in conjunction with, or as a replacement for bone scintigraphy (BS), in order to determine the extent of the disease. However, the questions on the diagnostic significance of these methods and the choice of the most effective approach to the management of children with bone sarcomas still remain unanswered. We conducted a systematic review and meta-analysis to compare the diagnostic roles of 18F-FDG PET/CT and BS in staging and restaging of bone sarcomas in children and young adults. The study was carried out in accordance with the Cochrane PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent researchers looked for prospective and retrospective studies evaluating the sensitivity and specificity of 18F-FDG PET/CT and BS in staging and restaging of bone sarcomas in children and young adults, published over the last 15 years. The quality of the included studies was assessed using the QUADAS-2 tool. Summary Receiver Operating Characteristic curves were calculated using STATA 17 software packages and the RevMan 5.3 tool to evaluate the overall diagnostic value of PET/CT and BS. The certainty of evidence was evaluated using the GRADE system. This systematic review and meta-analysis included 8 studies (530 patients with bone sarcomas). These studies used 11 patient cohorts (osteosarcoma: 5 cohorts, 305 patients; Ewing sarcoma: 6 cohorts, 225 patients). We discovered that 18F-FDG PET/CT had high sensitivity in staging and restaging of bone sarcomas (94% (95% confidence interval (CI) 89–97)). On the other hand, BS demonstrated lower sensitivity (69% (95% CI 58–79), the mean difference being 25% (95% CI 18.89–31.00), p < 0.001). At the same time, the specificity of 18F-FDG PET/CT and the specificity of BS were found to be comparable (96% (95% CI 83–99) and 92% (95% CI 82–97) respectively, p = 0.15). All the results were confirmed in a subgroup analysis of patients with osteosarcoma and Ewing sarcoma. The results of our systematic review and meta-analysis lead us to conclude that 18F-FDG PET/CT is a more sensitive method for staging and restaging of bone sarcomas in children and young adults, compared to BS. However, both methods have high specificity. Considering our findings, future clinical research in children with bone sarcomas should be aimed at further data collection to clarify the diagnostic roles of 18F-FDG PET/CT and BS both in children with osteosarcoma and in children with Ewing sarcoma, in order to identify clear indications and choose the best imaging method for detecting metastatic bone lesions, with the aim of developing an optimal diagnostic strategy.

Остеосаркома и саркома Юинга являются наиболее часто встречающимися первичными злокачественными заболеваниями костной ткани у детей. Точная диагностика и стадирование этих опухолей играют решающую роль в выборе оптимального лечения и прогнозировании исходов. В последние годы позитронно-эмиссионная томография, совмещенная с компьютерной томографией (ПЭТ/КТ), с 18F-фтордезоксиглюкозой (18F-ФДГ) все чаще используется в диагностике костных сарком для определения распространенности процесса совместно со сцинтиграфией костей скелета (СК) или вместо нее, но вопросы о диагностической значимости этих методов и выборе лучшего метода для ведения детей с костными саркомами остаются открытыми. Мы провели систематический обзор и метаанализ, чтобы сравнить диагностическую роль ПЭТ/КТ с 18F-ФДГ и СК у детей и молодых взрослых с костными саркомами при стадировании и рестадировании. Данное исследование было выполнено в соответствии с рекомендациями Кокрановского сообщества PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Двумя независимыми исследователями проведен поиск проспективных и ретроспективных исследований, оценивающих чувствительность и специфичность ПЭТ/КТ с 18F-ФДГ и СК в стадировании и рестадировании детей и молодых взрослых с костными саркомами, опубликованных за последние 15 лет. Качество включенных исследований было оценено с использованием инструмента QUADAS2. С применением программных пакетов STATA 17 и инструмента RevMan 5.3 рассчитывались сводные ROC-кривые для оценки общей диагностической ценности ПЭТ/КТ и СК. Оценка убедительности доказательств проводилась по системе GRADE. В данный систематический обзор и метаанализ были включены 8 исследований (530 пациентов с костными саркомами). Включенные исследования представляли 11 когорт пациентов (остеосаркома – 5 когорт, 305 пациентов; саркома Юинга – 6 когорт, 225 пациентов). Наши результаты показали, что ПЭТ/КТ с 18F-ФДГ обладает высокой чувствительностью в стадировании и рестадировании костных сарком – 94% (95% доверительный интервал (ДИ) 89–97). С другой стороны, СК показала меньшую чувствительность – 69% (95% ДИ 58–79), разница средних – 25% (95% ДИ 18,89–31,00), p < 0,001. Кроме того, наши результаты показали, что специфичность ПЭТ/КТ с 18F-ФДГ и СК была сопоставима – 96% (95% ДИ 83–99) и 92% (95% ДИ 82–97) соответственно, p = 0,15. Все результаты были подтверждены в анализе подгрупп пациентов с остеосаркомой и саркомой Юинга. На основании результатов нашего систематического обзора и метаанализа можно сделать вывод, что ПЭТ/КТ с 18F-ФДГ является более чувствительным методом для стадирования и рестадирования костных сарком у детей и молодых взрослых по сравнению с СК. Однако оба метода обладают высокой специфичностью. Учитывая полученные результаты метаанализа, будущие клинические исследования у детей с костными саркомами должны быть направлены на дальнейший набор данных по определению диагностической роли ПЭТ/КТ с 18F-ФДГ и СК как для детей с остеосаркомой, так и детей с саркомой Юинга для определения четких показаний и выбора наилучшего метода визуализации метастатического поражения костей скелета в целях разработки оптимального диагностического протокола.

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