Diagnostic performance of F-dihydroxyphenylalanine positron emission tomography in patients with paraganglioma: a meta-analysis.

Purpose: The aim of this study was to systematically review and conduct a meta-analysis of published data about the diagnostic performance of F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) in patients with paraganglioma (PG). Methods: A comprehensive computer literature search of studies published through 30 June 2011 regarding F-DOPA PET or PET/computed tomography (PET/CT) in patients with PG was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of F-DOPA PET or PET/CT in patients with PG on a per patient- and on a per lesion-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of F-DOPA PET or PET/CT in patients with PG. Furthermore, a sub-analysis taking into account the different genetic mutations in PG patients was also performed. Results: Eleven studies comprising 275 patients with suspected PG were included in this meta-analysis. The pooled sensitivity of F-DOPA PET and PET/CT in detecting PG was 91% [95% confidence interval (CI) 87-94%] on a per patient-based analysis and 79% (95% CI 76-81%) on a per lesion-based analysis. The pooled specificity of F-DOPA PET and PET/CT in detecting PG was 95% (95% CI 86-99%) on a per patient-based analysis and 95% (95% CI 84-99%) on a per lesion-based analysis. The area under the ROC curve was 0.95 on a per patient- and 0.94 on a per lesion-based analysis. Heterogeneity between the studies about sensitivity of F-DOPA PET or PET/CT was found. A significant increase in sensitivity of F-DOPA PET or PET/CT was observed when a sub-analysis excluding patients with succinate dehydrogenase subunit B (SDHB) gene mutations was performed. Conclusion: In patients with suspected PG F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. F-DOPA PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false-negative results should be kept in mind. Furthermore, SDHB gene mutations could influence F-DOPA PET or PET/CT diagnostic performance. [ABSTRACT FROM AUTHOR]