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