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2 December 2003 | Volume 139 Issue 11 | Pages 879-892
Purpose: To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non–small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT).
Data Sources: Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles.
Study Selection: Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non–small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement.
Data Extraction: One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data.
Data Synthesis: Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61% (interquartile range, 50% to 71%) and 79% (interquartile range, 66% to 89%), respectively. For FDG-PET, median sensitivity and specificity were 85% (interquartile range, 67% to 91%) and 90% (interquartile range, 82% to 96%), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100% [interquartile range, 90% to 100%]; median specificity, 78% [interquartile range, 68% to 100%]) than when CT showed no lymph node enlargement (median sensitivity, 82% [interquartile range, 65% to 100%]; median specificity, 93% [interquartile range, 92% to 100%]; P = 0.002).
Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University School of Medicine, Stanford, California.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Acknowledgments: The authors thank Jean-Dominique Delcroix, PhD, Eran Geller, MD, MS, Eric Hsiao, MD, and Annette Langer-Gould, MD, for reviewing non-English-language studies; James Fletcher, MD, Ann Leung, MD, and George Segall, MD, for helping to develop criteria for the technical quality of CT and FDG-PET; Christopher Stave, MLS, and Elaine Alligood, MLS, for assisting with literature searches; and Dena Bravata MD, MS, Lincoln Moses, PhD, and Trevor Hastie, PhD, for providing statistical advice.
Grant Support: Drs. Gould and Owens received Research Career Development Awards from the Veterans Affairs Health Services Research and Development Service. This study was also supported by Veterans Affairs Cooperative Study 27, "18-F-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) Imaging for Management of Patients with Solitary Pulmonary Nodules."
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Michael K. Gould, MD, MS, Pulmonary Section (111P), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304; e-mail, gould{at}stanford.edu.
Current Author Addresses: Drs. Gould and Kuschner: Veterans Affairs Palo Alto Health Care System (111P), 3801 Miranda Avenue, Palo Alto, CA 94304.
Ms. Rydzak: 201 Rawson Road #3, Brookline, MA 02445.
Ms. Maclean: 2614 Cedar Creek Drive, Durham, NC 27705.
Dr. Demas: 2330 Post Street, Suite 460, San Francisco, CA 94115.
Dr. Shigemitsu: Veterans Affairs Medical Center (111), 1030 Jefferson Avenue, Memphis, TN 38104.
Ms. Chan and Dr. Owens: Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford, CA 94305-6019.
Author Contributions: Conception and design: M.K. Gould, D.K. Owens.
Analysis and interpretation of the data: M.K. Gould, W.G. Kuschner, C.E. Rydzak, C.C. Maclean, H. Shigemitsu, D.K. Owens.
Drafting of the article: M.K. Gould, D.K. Owens.
Critical revision of the article for important intellectual content: M.K. Gould, W.G. Kuschner, C.E. Rydzak, C.C. Maclean, A.N. Demas, H. Shigemitsu, D.K. Owens.
Final approval of the article: M.K. Gould, W.G. Kuschner, C.E. Rydzak, C.C. Maclean, A.N. Demas, H. Shigemitsu, D.K. Owens.
Statistical expertise: M.K. Gould, D.K. Owens.
Obtaining of funding: M.K. Gould, D.K. Owens.
Administrative, technical, or logistic support: C.E. Rydzak, A.N. Demas, J.K. Chan.
Collection and assembly of data: M.K. Gould, W.G. Kuschner, C.E. Rydzak, C.C. Maclean, A.N. Demas, J.K. Chan. ARTICLE
Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non–Small-Cell Lung Cancer
A Meta-Analysis
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