Objective: To evaluate the predicting value of technetium-99m-sestambi (99mTc-MIBI) scintigraphy in the assessment of histological response to neoadjuvant chemotherapy in patients with osteosarcomas. Methods: A detailed search was made in Web of Science, PubMed, Elsevier, China National Knowledge Infrastructure (CNKI), Wanfang database for relevant original articles published in English or Chinese, up to April 2020; methodological quality of the included studies were also assessed. Two reviewers extracted data. Sufficient data were presented to construct a 2×2 contingency table. Pooled sensitivity, specificity were estimated. A summary receiver operating characteristic curve(ROC curve) was constructed. A χ2 test was performed to test for heterogeneity. The Der Simonian and Laird random effect model was applied if significant heterogeneity between studies was observed, while a fixed effect model was used in the absence of significant between-study heterogeneity. Results: Eight studies met the inclusion criteria. Six studies searched the relationship between alteration uptake ratio(AUR) and tumor necrosis ratio(TNR), including 134 patients. The pooled sensitivity, specificity and area under the ROC curve(AUC) for AUR ≥ 30% were 0.85(95%CI:0.74-0.93), 0.59(95%CI:0.47-0.70) and 0.84;for AUR ≥ 35% were 0.91(95%CI:0.79-0.98),0.68(95%CI:0.55-0.79) and 0.87;for AUR ≥ 38% were 0.87(95%CI:0.72-0.96), 0.80(95%CI:0.66-0.89) and 0.91, respectively. There were four studies revealing the relationship between washout rate(WR) and TNR, including 96 patients. The pooled sensitivity, specificity and AUC for WR ≤ 22% were 0.57(95%CI:0.37-0.75), 0.94(95%CI:0.85-0.98) and 0.90;for WR ≤ 25% were 0.70(95% CI:0.51-0.85), 0.86(95%CI:0.76-0.94) and 0.87, respectively. Conclusion: 99mTc-MIBI imaging, especially using AUR ≥ 38% and WRAUR ≤ 25% as cut-off values, can early and non-invasively predict histological response after neoadjuvant chemotherapy in osteosarcoma, and the predictive ability of AUR ≥ 38% is better than that of WRAUR ≤ 25%.
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