[18F]Fluorodeoxyglucose positron emission tomography-computerized tomography and lung cancer: a significant referral bias exists

Okereke, Ikenna; Gangadharan, Sidhu P.; Kent, Michael S.; Nicotera, Saila P.; DeCamp, Malcolm M.

doi:10.1016/j.ejcts.2010.07.039

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…14,24,26-29,32,39,45,46,48,50,52-54,58,60,62,64,67-69,72,74,75,77,80-83,85-88 In comparison, 23 studies with an average or median diameter greater than 2 cm had a slightly higher average adjusted sensitivity (91% [95% CI, 89%-93%]). 10,11,15,25,30,31,34,35,37,41,43,44,55-57,61,63,73,76,78,79,84,86 Specificity of FDG-PET to diagnose lung cancer was not significantly influenced by lesion size (74% for studies with lesions ≤2 cm and 75% for studies with larger average lesion size).…”

Section: Resultsmentioning

confidence: 94%

Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Deppen

Blume

Kensinger

et al. 2014

JAMA

155

119

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Importance Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is recommended for the non-invasive diagnosis of pulmonary nodules suspicious for lung cancer. In populations with endemic infectious lung disease, FDG-PET may not accurately identify malignant lesions. Objective To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the test accuracy in regions where infectious lung disease is rare. Data Sources and Study Selection Databases of MEDLINE, EMBASE and the Web of Science were searched from October 1, 2000, through April 28, 2014. Articles reporting information sufficient to calculate sensitivity and specificity of FDG-PET to diagnose lung cancer were included. Only studies that enrolled more than 10 participants with benign and malignant lesions were included. Database searches yielded 1923 articles, of which 257 were assessed for eligibility. Seventy studies were included in the analysis. Studies reported on a total of 8511 nodules; 5105 (60%) were malignant. Data Extraction and Synthesis Abstracts meeting eligibility criteria were collected by a research librarian and reviewed by 2 independent reviewers. Hierarchical summary receiver operating characteristic curves were constructed. A random-effects logistic regression model was used to summarize and assess the effect of endemic infectious lung disease on test performance. Main Outcome and Measures The sensitivity and specificity for FDG-PET test performance. Results Heterogeneity for sensitivity (I2=87%) and specificity (I2=82%) was observed across studies. The pooled (unadjusted) sensitivity was 89% (95% CI, 86%-91%) and specificity was 75% (95% CI, 71%-79%). There was a 16% lower average adjusted specificity in regions with endemic infectious lung disease (61% [95% CI, 49%-72%]) compared with nonendemic regions (77% [95% CI, 73%-80%]). Lower specificity was observed when the analysis was limited to rigorously conducted and well-controlled studies. In general, sensitivity did not change appreciably by endemic infection status, even after adjusting for relevant factors. Conclusions and Relevance The accuracy of FDG-PET for diagnosing lung nodules was extremely heterogeneous. Use of FDG-PET combined with computed tomography was less specific in diagnosing malignancy in populations with endemic infectious lung disease compared with nonendemic regions. These data do not support use of FDG-PET to diagnose lung cancer in endemic areas unless an institution achieves test performance accuracy similar to that found in nonendemic regions.

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Section: Resultsmentioning

confidence: 94%

Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Deppen

Blume

Kensinger

et al. 2014

JAMA

155

119

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“…1). The characteristics of the 56 studies was shown in Supporting Information Table 1 4–6, 14, 23–74. Among the included studies, 46 evaluated LN metastatic disease and 13 assessed extrathoracic metastatic disease.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non–small‐cell lung cancer patients

Zhang

et al. 2012

Intl Journal of Cancer

102

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In the recent years, fluorine 18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) has emerged as a new modality for staging non-small-cell lung cancer (NSCLC) patients. The aim of this meta-analysis was to assess the diagnostic value of 18 F-FDG PET/CT in detecting metastatic lesions in NSCLC patients. Meta-analysis methods were used to pool sensitivity, specificity, positive and negative likehood ratios, diagnostic odd ratios and to construct a summary receiver-operating characteristic curve. Data from included studies were pooled to compare the diagnostic accuracy between PET/CT and PET or CT alone in nodal staging. Totally, 56 studies involving 8,699 patients met the inclusion criteria. Lung cancer is the leading cause of tumor-related deaths worldwide, and non-small-cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. 1 The current criteria for staging NSCLC is based on the TNM system, 2 which determines treatment options and predicts survival. 3 So, staging NSCLC is important, and accurate clinical methods are in great need. Various diagnostic methods have been used for staging NSCLC. [4][5][6][7] Computed tomography (CT) has been widely used to evaluate the nodal status of lung cancer based on the size or shape of the lymph nodes. 8 However, the sensitivity and the specificity were relatively low, because the lymph node size may not correlate with the presence of metastatic disease. 9 Based on the fact that malignant cells show higher rates of glycolysis than most surrounding normal structures, 10 fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been introduced and developed as an effective modality for tumor staging in a variety of cancers. 11 However, PET has relatively poor spatial resolution, thus limits its anatomical localization of lesions. 12 Mediastinoscopy, endobronchial and endoscopic ultrasound, and other surgical procedures are frequently used for thoracic nodal evaluation in lung cancer, but these techniques are invasive and cumbersome. 7,13 In the past recent years, 18 F-FDG PET/CT has emerged as a new modality for staging NSCLC patients. 4,14 The aim of this study was to evaluate the diagnostic accuracy of 18 F-FDG PET/CT in detecting metastases in NSCLC patients. Material and Methods Selection criteriaSelection criteria were given as follows: (1) 18 F-FDG PET/CT was used for the evaluation of lymph node (LN) metastases or extrapulmonary metastases in NSCLC; (2) histologic assessment should be applied as reference standard for LN metastases; for studies evaluated extrathoracic metastases, other reference standards such as imaging modality, radiological and clinical follow-up were also applied; (3) absolute numbers of true-positive (TP), false-positive (FP), true-

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“…Data are pooled estimates for all 24 studies(9,11,12,17,21,23,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(47)(48)(49)51,52…”

mentioning

confidence: 99%

Fluorine 18–FDG PET/CT and Diffusion-weighted MRI for Malignant versus Benign Pulmonary Lesions: A Meta-Analysis

Dias¹,

Zanon²,

Altmayer³

et al. 2019

Radiology

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To perform a meta-analysis of the literature to compare the diagnostic performance of fluorine 18 fluorodeoxyglucose PET/CT and diffusion-weighted (DW) MRI in the differentiation of malignant and benign pulmonary nodules and masses. Materials and Methods:Published English-language studies on the diagnostic accuracy of PET/CT and/or DW MRI in the characterization of pulmonary lesions were searched in relevant databases through December 2017. The primary focus was on studies in which joint DW MRI and PET/CT were performed in the entire study population, to reduce interstudy heterogeneity. For DW MRI, lesion-to-spinal cord signal intensity ratio and apparent diffusion coefficient were evaluated; for PET/CT, maximum standard uptake value was evaluated. The pooled sensitivities, specificities, diagnostic odds ratios, and areas under the receiver operating characteristic curve (AUCs) for PET/CT and DW MRI were determined along with 95% confidence intervals (CIs). Results:Thirty-seven studies met the inclusion criteria, with a total of 4224 participants and 4463 lesions (3090 malignant lesions [69.2%]). In the primary analysis of joint DW MRI and PET/CT studies (n = 6), DW MRI had a pooled sensitivity and specificity of 83% (95% CI: 75%, 89%) and 91% (95% CI: 80%, 96%), respectively, compared with 78% (95% CI: 70%, 84%) (P = .01 vs DW MRI) and 81% (95% CI: 72%, 88%) (P = .056 vs DW MRI) for PET/CT. DW MRI yielded an AUC of 0.93 (95% CI: 0.90, 0.95), versus 0.86 (95% CI: 0.83, 0.89) for PET/CT (P = .001). The diagnostic odds ratio of DW MRI (50 [95% CI: 19, 132]) was superior to that of PET/CT (15 [95% CI: 7, 32]) (P = .006). Conclusion:The diagnostic performance of diffusion-weighted MRI is comparable or superior to that of fluorine 18 fluorodeoxyglucose PET/CT in the differentiation of malignant and benign pulmonary lesions.

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[18F]Fluorodeoxyglucose positron emission tomography-computerized tomography and lung cancer: a significant referral bias exists

Cited by 4 publications

References 14 publications

Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non–small‐cell lung cancer patients

Fluorine 18–FDG PET/CT and Diffusion-weighted MRI for Malignant versus Benign Pulmonary Lesions: A Meta-Analysis

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