Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non–Small-Cell Lung Cancer

  1. Michael K. Gould, MD, MS;
  2. Ware G. Kuschner, MD;
  3. Chara E. Rydzak, BA;
  4. Courtney C. Maclean, BA;
  5. Anita N. Demas, MD;
  6. Hidenobu Shigemitsu, MD;
  7. Jo Kay Chan, BS; and
  8. Douglas K. Owens, MD, MS
  1. From Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University School of Medicine, Stanford, California.
    1. Figure 1. The initial search took place from 1966 through 1 June 2002, and the supplemental search took place from 1998 through 27 March 2003. PET = positron emission tomography.
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        Figure 1. The initial search took place from 1966 through 1 June 2002, and the supplemental search took place from 1998 through 27 March 2003. PET = positron emission tomography. Reports evaluated for inclusion in the meta-analysis.
      • Figure 2. Error bars represent 95% CIs. Three studies reported results by using both the patient and lymph nodes or lymph node stations as the units of analysis; these 3 studies are listed twice .
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          Figure 2. Error bars represent 95% CIs. Three studies reported results by using both the patient and lymph nodes or lymph node stations as the units of analysis; these 3 studies are listed twice . Individual study estimates of sensitivity and 1 − specificity of computed tomography for identifying mediastinal metastasis.(70, 74, 75)
        • Figure 3. Error bars represent 95% CIs. Five studies reported results by using both the patient and lymph nodes or lymph node stations as the units of analysis; these 5 studies are listed twice .
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            Figure 3. Error bars represent 95% CIs. Five studies reported results by using both the patient and lymph nodes or lymph node stations as the units of analysis; these 5 studies are listed twice . Individual study estimates of sensitivity and 1 − specificity of positron emission tomography with 18-fluorodeoxyglucose for identifying mediastinal metastasis.(70, 73-75, 96)
          • Figure 4. Individual study estimates of sensitivity and 1 − specificity are shown for FDG-PET ( ) and CT ( ). The approximate points on the curves where FDG-PET and CT operate in current practice are indicated ( and , respectively).
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              Figure 4. Individual study estimates of sensitivity and 1 − specificity are shown for FDG-PET ( ) and CT ( ). The approximate points on the curves where FDG-PET and CT operate in current practice are indicated ( and , respectively). Summary receiver-operating characteristic curves and 95% CIs for mediastinal staging with positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) and computed tomography (CT).open circles□ssolid circlesolid square
            • Figure 5. Individual study estimates of sensitivity and 1 − specificity are shown for positron emission tomography with 18-fluorodeoxyglucose in patients with enlarged lymph nodes ( ) and without enlarged lymph nodes ( ). The 2 receiver-operating characteristic curves are nearly identical. However, in patients with enlarged lymph nodes on CT, studies tend to cluster on a portion of the curve at which sensitivity is favored over specificity. In patients without lymph node enlargement, studies tend to cluster on a portion of the curve at which specificity is favored over sensitivity. The approximate points on the curves where positron emission tomography with 18-fluorodeoxyglucose operates in current practice in patients with and without lymph node enlargement are indicated ( and , respectively). The discriminant function that separates the 2 groups of patients is shown ( ) ( = 0.002 by nonparametric permutation test).
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                Figure 5. Individual study estimates of sensitivity and 1 − specificity are shown for positron emission tomography with 18-fluorodeoxyglucose in patients with enlarged lymph nodes ( ) and without enlarged lymph nodes ( ). The 2 receiver-operating characteristic curves are nearly identical. However, in patients with enlarged lymph nodes on CT, studies tend to cluster on a portion of the curve at which sensitivity is favored over specificity. In patients without lymph node enlargement, studies tend to cluster on a portion of the curve at which specificity is favored over sensitivity. The approximate points on the curves where positron emission tomography with 18-fluorodeoxyglucose operates in current practice in patients with and without lymph node enlargement are indicated ( and , respectively). The discriminant function that separates the 2 groups of patients is shown ( ) ( = 0.002 by nonparametric permutation test). Summary receiver-operating characteristic curves for mediastinal staging with positron emission tomography with 18-fluorodeoxyglucose in patients with and without mediastinal lymph node enlargement on computed tomography (CT).□sopen circlessolid squaresolid circledashed lineP
              • Figure 6. Post-test probabilities are shown as a function of pretest probability in patients with positive FDG-PET results and enlarged lymph nodes on CT ( ), patients with positive FDG-PET results and no enlarged lymph nodes on CT ( ), patients with negative FDG-PET results and enlarged lymph nodes on CT ( ), and patients with negative FDG-PET results and no enlarged lymph nodes on CT ( ).
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                  Figure 6. Post-test probabilities are shown as a function of pretest probability in patients with positive FDG-PET results and enlarged lymph nodes on CT ( ), patients with positive FDG-PET results and no enlarged lymph nodes on CT ( ), patients with negative FDG-PET results and enlarged lymph nodes on CT ( ), and patients with negative FDG-PET results and no enlarged lymph nodes on CT ( ). Post-test probabilities of mediastinal metastasis after computed tomography (CT) and positron emission tomography with 18-fluorodeoxyglucose (FDG-PET).circlessquarestrianglesdiamonds
                • Appendix Figure. Post-test probabilities are shown as a function of pretest probability in patients with positive FDG-PET results and enlarged lymph nodes on CT ( ), patients with positive FDG-PET results and no enlarged lymph nodes on CT ( ), patients with negative FDG-PET results and enlarged lymph nodes on CT ( ), and patients with negative FDG-PET results and no enlarged lymph nodes on CT ( ). When unconditional estimates of FDG-PET performance are used to make the calculations, post-test probabilities are overestimated when FDG-PET results are positive and CT shows enlarged lymph nodes ( ), underestimated when FDG-PET results are positive and CT shows no enlarged lymph nodes ( ), overestimated when FDG-PET results are negative and CT shows enlarged lymph nodes ( ), and underestimated when FDG-PET results are negative and CT shows no enlarged lymph nodes ( ).
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                    Appendix Figure. Post-test probabilities are shown as a function of pretest probability in patients with positive FDG-PET results and enlarged lymph nodes on CT ( ), patients with positive FDG-PET results and no enlarged lymph nodes on CT ( ), patients with negative FDG-PET results and enlarged lymph nodes on CT ( ), and patients with negative FDG-PET results and no enlarged lymph nodes on CT ( ). When unconditional estimates of FDG-PET performance are used to make the calculations, post-test probabilities are overestimated when FDG-PET results are positive and CT shows enlarged lymph nodes ( ), underestimated when FDG-PET results are positive and CT shows no enlarged lymph nodes ( ), overestimated when FDG-PET results are negative and CT shows enlarged lymph nodes ( ), and underestimated when FDG-PET results are negative and CT shows no enlarged lymph nodes ( ). Post-test probabilities of mediastinal metastasis after computed tomography (CT) and positron emission tomography with 18-fluorodeoxyglucose (FDG-PET).solid circlessolid squaressolid trianglessolid diamondsopen circles□s▵sopen diamonds

                  Summary for Patients

                  • Summaries for Patients:Detecting Spread of Non–Small-Cell Lung Cancer within the Chest Ann Intern Med December 2, 2003 139:I-18
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                  1. Ann Intern Med December 2, 2003 vol. 139 no. 11 879-892
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