Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: A meta-analysis

Michael K. Gould, Courtney C. Maclean, Ware G. Kuschner, Chara Rydzak, Douglas K. Owens

Research output: Contribution to journalReview article

900 Citations (Scopus)

Abstract

Context: Focal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions. Objective: To estimate the diagnostic accuracy of FDG-PET for malignant focal pulmonary lesions. Data Sources: Studies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Study Selection: Studies that examined FDG-PET or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the anaylsis. Data Extraction: Two reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion. Data Synthesis: We used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete, For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET was 91.2% (95% confidence interval, 89.1%-92.9%). In current practice, FDG-PET operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8% and 77.8%, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P=.43), for semiquantitative methods of image interpretation compared with qualitative methods (P=.52), or for FDG-PET compared with FDG imaging with a modified gamma camera in coincidence mode (P=.19). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET has high sensitivity and intermediate specificity for malignancy.

Original languageEnglish (US)
Pages (from-to)914-924
Number of pages11
JournalJournal of the American Medical Association
Volume285
Issue number7
DOIs
StatePublished - Feb 21 2001
Externally publishedYes

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Positron-Emission Tomography
Meta-Analysis
Lung
Sensitivity and Specificity
ROC Curve
Gamma Cameras
Information Storage and Retrieval
MEDLINE
Sample Size
Neoplasms
Joints
Research Personnel
Databases
Confidence Intervals
Glucose

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions : A meta-analysis. / Gould, Michael K.; Maclean, Courtney C.; Kuschner, Ware G.; Rydzak, Chara; Owens, Douglas K.

In: Journal of the American Medical Association, Vol. 285, No. 7, 21.02.2001, p. 914-924.

Research output: Contribution to journalReview article

Gould, Michael K. ; Maclean, Courtney C. ; Kuschner, Ware G. ; Rydzak, Chara ; Owens, Douglas K. / Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions : A meta-analysis. In: Journal of the American Medical Association. 2001 ; Vol. 285, No. 7. pp. 914-924.
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abstract = "Context: Focal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions. Objective: To estimate the diagnostic accuracy of FDG-PET for malignant focal pulmonary lesions. Data Sources: Studies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Study Selection: Studies that examined FDG-PET or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the anaylsis. Data Extraction: Two reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion. Data Synthesis: We used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete, For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET was 91.2{\%} (95{\%} confidence interval, 89.1{\%}-92.9{\%}). In current practice, FDG-PET operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8{\%} and 77.8{\%}, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P=.43), for semiquantitative methods of image interpretation compared with qualitative methods (P=.52), or for FDG-PET compared with FDG imaging with a modified gamma camera in coincidence mode (P=.19). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET has high sensitivity and intermediate specificity for malignancy.",
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T1 - Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions

T2 - A meta-analysis

AU - Gould, Michael K.

AU - Maclean, Courtney C.

AU - Kuschner, Ware G.

AU - Rydzak, Chara

AU - Owens, Douglas K.

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N2 - Context: Focal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions. Objective: To estimate the diagnostic accuracy of FDG-PET for malignant focal pulmonary lesions. Data Sources: Studies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Study Selection: Studies that examined FDG-PET or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the anaylsis. Data Extraction: Two reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion. Data Synthesis: We used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete, For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET was 91.2% (95% confidence interval, 89.1%-92.9%). In current practice, FDG-PET operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8% and 77.8%, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P=.43), for semiquantitative methods of image interpretation compared with qualitative methods (P=.52), or for FDG-PET compared with FDG imaging with a modified gamma camera in coincidence mode (P=.19). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET has high sensitivity and intermediate specificity for malignancy.

AB - Context: Focal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions. Objective: To estimate the diagnostic accuracy of FDG-PET for malignant focal pulmonary lesions. Data Sources: Studies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Study Selection: Studies that examined FDG-PET or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the anaylsis. Data Extraction: Two reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion. Data Synthesis: We used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete, For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET was 91.2% (95% confidence interval, 89.1%-92.9%). In current practice, FDG-PET operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8% and 77.8%, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P=.43), for semiquantitative methods of image interpretation compared with qualitative methods (P=.52), or for FDG-PET compared with FDG imaging with a modified gamma camera in coincidence mode (P=.19). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET has high sensitivity and intermediate specificity for malignancy.

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