Daniel I. Steinberg, MD
In patients with a solitary pulmonary nodule, how accurate are imaging techniques for diagnosing cancer?
Studies selected evaluated dynamic contrast-enhanced computed tomography (CT), dynamic contrast-enhanced magnetic resonance imaging (MRI), fluorine 18 fluorodeoxyglucose positron emission tomography (FDG–PET), or functional technetium 99m depreotide single-photon emission CT (SPECT) for assessment of solitary pulmonary nodules in ≥ 10 patients. The reference standard was histologic diagnosis in > 50% of patients (with clinical follow-up for the remainder). Outcomes were pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver-operating characteristic curve.
MEDLINE (1990 to 2005) was searched for studies published in English (or with an English abstract) as peer-reviewed, full-length articles. 44 studies (n = 2867, mean age 60 y, mean nodule size 19 mm) met the selection criteria, 24 of which were prospective. 19 studies used histologic diagnosis for all patients, and 19 studies reported blinded interpretation of test results.
The Table shows the diagnostic test characteristics for the 4 techniques.
Dynamic contrast-enhanced computed tomography and magnetic resonance imaging, fluorine 18 fluorodeoxyglucose positron emission tomography, and technetium 99m depreotide single-photon emission computed tomography have similar sensitivity and specificity for diagnosing cancer in solitary pulmonary nodules.
Test characteristics of 4 imaging techniques for diagnosing cancer in solitary pulmonary nodules*
*ROC = receiver-operating characteristic; diagnostic terms and CI defined in Glossary.
Steinberg DI. Review: Imaging techniques have similarly high accuracy for diagnosing cancer in solitary pulmonary nodules. Ann Intern Med. 2008;149:JC1–12. doi: 10.7326/0003-4819-149-2-200807150-02012
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Published: Ann Intern Med. 2008;149(2):JC1-12.
Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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