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
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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.
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Hematology/Oncology, Pulmonary/Critical Care, Lung Cancer.
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