Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer: A Meta-Analysis

Michael K. Gould, Ware G. Kuschner, Chara Rydzak, Courtney C. Maclean, Anita N. Demas, Hidenobu Shigemitsu, Jo Kay Chan, Douglas K. Owens

Research output: Contribution to journalReview article

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Abstract

Purpose: To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT). Data Sources: Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles. Study Selection: Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non-small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement. Data Extraction: One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data. Data Synthesis: Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61% (interquartile range, 50% to 71%) and 79% (interquartile range, 66% to 89%), respectively. For FDG-PET, median sensitivity and specificity were 85% (interquartile range, 67% to 91%) and 90% (interquartile range, 82% to 96%), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100% [interquartile range, 90% to 100%]; median specificity, 78% [interquartile range, 68% to 100%]) than when CT showed no lymph node enlargement (median sensitivity, 82% [interquartile range, 65% to 100%]; median specificity, 93% [interquartile range, 92% to 100%]; P = 0.002). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.

Original languageEnglish (US)
JournalAnnals of internal medicine
Volume139
Issue number11
DOIs
StatePublished - Dec 2 2003
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Positron-Emission Tomography
Meta-Analysis
Tomography
Lymph Nodes
Sensitivity and Specificity
Language
Information Storage and Retrieval
Positron Emission Tomography Computed Tomography
MEDLINE
ROC Curve
Neoplasm Metastasis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer : A Meta-Analysis. / Gould, Michael K.; Kuschner, Ware G.; Rydzak, Chara; Maclean, Courtney C.; Demas, Anita N.; Shigemitsu, Hidenobu; Chan, Jo Kay; Owens, Douglas K.

In: Annals of internal medicine, Vol. 139, No. 11, 02.12.2003.

Research output: Contribution to journalReview article

Gould, Michael K. ; Kuschner, Ware G. ; Rydzak, Chara ; Maclean, Courtney C. ; Demas, Anita N. ; Shigemitsu, Hidenobu ; Chan, Jo Kay ; Owens, Douglas K. / Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer : A Meta-Analysis. In: Annals of internal medicine. 2003 ; Vol. 139, No. 11.
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title = "Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer: A Meta-Analysis",
abstract = "Purpose: To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT). Data Sources: Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles. Study Selection: Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non-small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement. Data Extraction: One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data. Data Synthesis: Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61{\%} (interquartile range, 50{\%} to 71{\%}) and 79{\%} (interquartile range, 66{\%} to 89{\%}), respectively. For FDG-PET, median sensitivity and specificity were 85{\%} (interquartile range, 67{\%} to 91{\%}) and 90{\%} (interquartile range, 82{\%} to 96{\%}), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100{\%} [interquartile range, 90{\%} to 100{\%}]; median specificity, 78{\%} [interquartile range, 68{\%} to 100{\%}]) than when CT showed no lymph node enlargement (median sensitivity, 82{\%} [interquartile range, 65{\%} to 100{\%}]; median specificity, 93{\%} [interquartile range, 92{\%} to 100{\%}]; P = 0.002). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.",
author = "Gould, {Michael K.} and Kuschner, {Ware G.} and Chara Rydzak and Maclean, {Courtney C.} and Demas, {Anita N.} and Hidenobu Shigemitsu and Chan, {Jo Kay} and Owens, {Douglas K.}",
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month = "12",
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doi = "10.7326/0003-4819-139-11-200311180-00013",
language = "English (US)",
volume = "139",
journal = "Annals of Internal Medicine",
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TY - JOUR

T1 - Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer

T2 - A Meta-Analysis

AU - Gould, Michael K.

AU - Kuschner, Ware G.

AU - Rydzak, Chara

AU - Maclean, Courtney C.

AU - Demas, Anita N.

AU - Shigemitsu, Hidenobu

AU - Chan, Jo Kay

AU - Owens, Douglas K.

PY - 2003/12/2

Y1 - 2003/12/2

N2 - Purpose: To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT). Data Sources: Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles. Study Selection: Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non-small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement. Data Extraction: One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data. Data Synthesis: Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61% (interquartile range, 50% to 71%) and 79% (interquartile range, 66% to 89%), respectively. For FDG-PET, median sensitivity and specificity were 85% (interquartile range, 67% to 91%) and 90% (interquartile range, 82% to 96%), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100% [interquartile range, 90% to 100%]; median specificity, 78% [interquartile range, 68% to 100%]) than when CT showed no lymph node enlargement (median sensitivity, 82% [interquartile range, 65% to 100%]; median specificity, 93% [interquartile range, 92% to 100%]; P = 0.002). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.

AB - Purpose: To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT). Data Sources: Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles. Study Selection: Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non-small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement. Data Extraction: One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data. Data Synthesis: Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61% (interquartile range, 50% to 71%) and 79% (interquartile range, 66% to 89%), respectively. For FDG-PET, median sensitivity and specificity were 85% (interquartile range, 67% to 91%) and 90% (interquartile range, 82% to 96%), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100% [interquartile range, 90% to 100%]; median specificity, 78% [interquartile range, 68% to 100%]) than when CT showed no lymph node enlargement (median sensitivity, 82% [interquartile range, 65% to 100%]; median specificity, 93% [interquartile range, 92% to 100%]; P = 0.002). Conclusions: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.

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U2 - 10.7326/0003-4819-139-11-200311180-00013

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