Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis

Abstract

BackgroundAccurate clinical staging of mediastinal lymph nodes of patients with lung cancer is important in determining therapeutic options and prognoses. We aimed to compare the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting mediastinal nodal metastasis of lung cancer.MethodsRelevant studies were systematically searched in the MEDLINE, EMBASE, PUBMED, and Cochrane Library databases. Based on extracted data, the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR) with individual 95% confidence intervals were calculated. In addition, the publication bias was assessed by Deek’s funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses.ResultsForty-three studies were finally included. For PET/CT, the pooled sensitivity and specificity were 0.65 (0.63–0.67) and 0.93 (0.93–0.94), respectively. The corresponding values of DWI were 0.72 (0.68–0.76) and 0.97 (0.96–0.98), respectively. The overall PLR and NLR of DWI were 13.15 (5.98–28.89) and 0.32 (0.27–0.39), respectively. For PET/CT, the corresponding values were 8.46 (6.54–10.96) and 0.38 (0.33–0.45), respectively. The Deek’s test revealed no significant publication bias. Study design and patient enrollment were potential causes for the heterogeneity of DWI studies and the threshold was a potential source for PET/CT studies.ConclusionBoth modalities are beneficial in detecting lymph nodes metastases in lung cancer without significant differences between them. DWI might be an alternative modality for evaluating nodal status of NSCLC.

18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)-Radiomics of metastatic lymph nodes and primary tumor in non-small cell lung cancer (NSCLC) – A prospective externally validated study

“…Diffusion-weighted magnetic resonance imaging (DWI) is also a solid alternative for lymph node detection, as proven by the work of Shen et. al [ 31 ]. In the work carried out, given the availability of FDG-PET-CT scans for all patients under analysis as part of their protocol for radiotherapy treatment, we proceeded the analysis with lymph nodes detected using this imaging modality.…”

A review of the role of MRI in diagnosis and treatment of early stage lung cancer

“…StarVIBE was also successful in outperforming standard DCE for functional assessments in the setting of motion [22]. Although a full analysis of the utility of whole-body MRI to assess potential metastatic disease is beyond the scope of this review, significant motion artifacts have traditionally limited utility [23]. However, emerging data suggest the technological improvements noted above have improved the viability of whole-body MRI for initial staging [24].…”

Lung cancer staging: a concise update

“…However, two clinical trials did not find differences in the diagnostic value of PET-CT and diffusion MRI for staging lung cancer [32,33]. Diffusion-weighted MRI could be considered in some cases as an alternative to PET-CT [34], but more studies are needed to establish the role of MRI in the study of the N descriptors in lung cancer.…”