Michael K. Gould, MD, MS; Ware G. Kuschner, MD; Chara E. Rydzak, BA; Courtney C. Maclean, BA; Anita N. Demas, MD; Hidenobu Shigemitsu, MD; Jo Kay Chan, BS; Douglas K. Owens, MD, MS
Gould MK, Kuschner WG, Rydzak CE, Maclean CC, Demas AN, Shigemitsu H, et al. Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non–Small-Cell Lung Cancer: A Meta-Analysis. Ann Intern Med. 2003;139:879-892. doi: 10.7326/0003-4819-139-11-200311180-00013
Download citation file:
Published: Ann Intern Med. 2003;139(11):879-892.
Is computed tomography (CT) or positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) better for mediastinal staging of non–small-cell lung cancer?
This synthesis of 39 studies found that FDG-PET was more accurate than CT for identifying lymph node involvement. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged nodes than when CT showed no node enlargement.
Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Because FDG-PET has more true-positive and false-positive findings in patients with enlarged nodes, positive findings warrant biopsy confirmation. Interpretation of negative FDG-PET findings should rely heavily on pretest probability of metastasis regardless of CT findings.
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.
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 .
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 .
Appendix Table 1.
Appendix Table 2.
Appendix Table 3.
Appendix Table 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).
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).
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 ( ).
Appendix Table 5.
Appendix Table 6.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only