Review ArticlesBone single-photon emission computed tomography/computed tomography in cancer care in the past decade: a systematic review and meta-analysis as well as recommendations for further workMohd Rohani, Mohd Fazrina; Zanial, Ahmad Zaida; Suppiah, Subapriyaa,,b; Phay Phay, Khora; Mohamed Aslum Khan, Farahnaza; Mohamad Najib, Fatin Hayyania; Mohd Noor, Noramalizab; Arumugam, Manoharc; Amir Hassan, Siti Zarinaa; Vinjamuri, SobhandAuthor Information aDepartment of Nuclear Medicine, Hospital Kuala Lumpur bDepartment of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia cDepartment of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia dDepartment of Nuclear Medicine, The Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK Received 18 July 2020 Accepted 10 September 2020 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.nuclearmedicinecomm.com. Correspondence to Subapriya Suppiah, Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia, Tel: +603 9769 1641; e-mail: [email protected] Nuclear Medicine Communications: January 2021 - Volume 42 - Issue 1 - p 9-20 doi: 10.1097/MNM.0000000000001306 Buy SDC Metrics Abstract Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91–0.95] and 96.0% (95% CI 0.94–0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.