Systematic Review & Meta-Analysis of Positron Emission Tomography/Computed Tomography and Bone Scan in the Diagnosis of Prostate Lesions

Jiafu Wang; Yue Han; Lin Lin; Linhan Zhang; Jin Li; Huiqi Gao; Peng Fu

Transl Androl Urol. 2021;10(11):4231-4240.

Conclusions

In this study, 3 articles related to the diagnosis of bone metastases by ⁶⁸Ga-PSMA PET/CT and BS were screened to compare the diagnostic value of the two methods. The results of the meta-analysis showed that ⁶⁸Ga-PSMA PET/CT had clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve diagnostic accuracy. The shortcomings of this study lie in the small sample size and the lack of unified diagnostic criteria for each study; these criteria are easily influenced by subjective factors associated with individual researchers and may result in implementation bias. Unified diagnostic criteria are therefore required for further exploration. For cases with fewer bone metastases, it is often difficult to make an accurate judgment from a BS, while ⁶⁸Ga-PSMA PET/CT can show soft tissues and organs in addition to bones to find metastatic lesions. ⁶⁸Ga-PSMA PET/CT not only generates clear images, but can also accurately distinguish the pleura, ribs, and muscles of the chest wall. In conclusion, this study supports the use of PET/CT scans for the clinical diagnosis of bone metastases from malignant prostate lesions.

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Acknowledgments
Funding
None.

Reporting Checklist
The authors have completed the PRISMA reporting checklist. Available at https://dx.doi.org/10.21037/tau-21-912

Ethical Statement
The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Table 1. Basic contents of QUADAS2 quality assessment tool
Entry	Describe	Signature problem	Risk of bias (high/low/unclear)	Clinical adaptability (high/low risk/unclear)
Case selection	(I) The manner in which case selection was depicted	Are randomized controlled trials included? Is the elimination of unreasonable cases avoided?	Risk assessment of bias in case selection	Evaluation of the actual clinical application of the included cases
Case selection	(II) Describe the specifics of the included cases		Risk assessment of bias in case selection
Test to be evaluated	Describe an explanation of the process to be tested or implemented	Was the test to be evaluated performed without knowledge of the gold standard?	Bias risk assessment of the test to be evaluated	Evaluation of the actual clinical use of the included cases
The gold standard	Description of the gold standard and an explanation of the implementation process	Does the gold standard correctly distinguish target disease states?	Gold standard bias risk assessment	The implementation process of the test to be evaluated and the matching situation between the interpretation and the evaluation problem
Case flow and progress	(I) Describe cases in which diagnostic tests have not been performed, cases that do not have a gold standard	Does the gold standard use blinding to interpret the results?	Is there only one gold standard for all cases? Do all cases receive the same gold standard? Were all cases included in the study analysis?	Risk assessment of bias in case flow and progression
Case flow and progress	(II) Describe the time interval between the diagnostic test and the gold standard test			Risk assessment of bias in case flow and progression

Table 2. Basic information for the included literature
Author	Published year	N (cases)	Age (years)	⁶⁸Ga-PSMA PET/CT				Bone scan				Diagnostic criteria
Author	Published year	N (cases)	Age (years)	TP	FP	FN	TN	TP	FP	FN	TN	Diagnostic criteria
Uslu-Beşli L (17)	2019	28	67.3	10	0	1	17	8	8	3	9	PET/CT, BS, CT, MRI
Lengana T (18)	2018	113	66	25	0	1	87	19	11	7	76	PET/CT, BS, CT, MRI, pathology
Kumar A (19)	2018	74	–	49	0	2	53	47	1	4	22	PET/CT, BS, pathology

⁶⁸Ga-PSMA, ⁶⁸Ga-prostate specific membrane antibody; PET, positron emission tomography; CT, computed tomography; TP, true positive; FP, false positive; TN, true negative; FN, false negative; BS, bone scan; MRI, magnetic resonance imaging.