The diagnostic utility of SATB2 immunohistochemistry as an adjunct for differentiating osteogenic from non-osteogenic bone tumors: A systematic review and Meta-analysis.

[BACKGROUND] This study aimed to evaluate the diagnostic value of special AT-rich sequence binding protein 2 (SATB2) in distinguishing between osteogenic tumors and non-osteogenic tumors, providing reliable scientific evidence for its use as an adjunct diagnostic tool in clinical practice.

[METHODS] We conducted systematic searches of the PubMed, EMBASE, Cochrane Library, and Web of Science databases to identify all relevant literature published up to June 2025 that studied SATB2 in the differential diagnosis between osteogenic and non-osteogenic tumors. The QUADAS-2 tool was used to evaluate the methodological quality of each included study. Meta-analysis was performed using STATA SE-64 and RevMan 5.4 software.

[RESULTS] 10 studies involving a total of 1234 cases were included, comprising 494 patients with osteogenic tumors and 740 patients with non-osteogenic tumors. The pooled sensitivity and specificity of SATB2 for differentiating osteogenic from non-osteogenic tumors were 0.97 (95 % CI: 0.90-0.99) and 0.88 (95 % CI: 0.73-0.96), respectively. The PLR was 8.17 (95 % CI: 3.30-20.23), and the NLR was 0.03 (95 % CI: 0.01-0.12). The DOR was 252.82 (95 % CI: 41.85-1527.16). The AUC was 0.98 (95 % CI: 0.97-0.99).

[CONCLUSION] SATB2 demonstrates high sensitivity and robust specificity as an adjunct diagnostic marker for differentiating osteogenic from non-osteogenic tumors. However, it should be noted that this study excluded tumors with ambiguous definitions, such as giant cell tumors of bone. Future research should further validate the clinical utility of SATB2 in these and other challenging lesions.