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Nuclear Medicine |
1 From the Department of Internal Medicine, Division of Nuclear Medicine (B.A.D., J.O.A., R.L.W.), the Departments of Radiology (R.L.W.) and Surgery (S.S.S.), and the Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies (CHOICES) (S.S.S.), University of Michigan Medical Center, 1500 E Medical Center Dr, UH B1G 412, Ann Arbor, MI 48109-0028. From the 1997 RSNA scientific assembly. Received April 26, 1998; revision requested November 9; revision received February 4, 1999; accepted June 8. Address reprint requests to R.L.W.
PURPOSE: To meta-analytically compare 2-[fluorine 18]fluoro-2-deoxy-D-glucose positron emission tomography (PET) and computed tomography (CT) for the demonstration of mediastinal nodal metastases in patients with non–small cell lung cancer.
MATERIALS AND METHODS: English-language reports on the diagnostic performance of PET (14 studies, 514 patients) and/or CT (29 studies, 2,226 patients) for demonstration of mediastinal nodal metastases from NSCLC were selected by using the MEDLINE database. In eligible studies, an objective diagnostic standard was used, data were presented to allow recalculation of contingency tables, and established diagnostic criteria were used for abnormal test results. Summary receiver operating characteristic (ROC) curves were calculated.
RESULTS: Pooled point estimates of diagnostic performance and summary ROC curves indicated that PET was significantly more accurate than CT for demonstration of nodal metastases (P < .001). Mean sensitivity and specificity (± 95% CI) were 0.79 ± 0.03 and 0.91 ± 0.02, respectively, for PET and 0.60 ± 0.02 and 0.77 ± 0.02, respectively, for CT. The log odds ratios were 1.79 (95% CI: 1.49, 2.09) for CT and 3.77 (95% CI: 2.77, 4.77) for PET (P < .001). Subgroup analyses did not alter findings.
CONCLUSION: PET is superior to CT for mediastinal staging of non–small cell lung cancer, independent of performance index or clinical context of PET imaging.
Index terms: Computed tomography (CT), comparative studies, 996.1291 • Positron emission tomography (PET), comparative studies, 996.12963 • Lung neoplasms, metastases, 60.321, 67.33 • Lymphatic system, neoplasms, 996.33 • Lymphatic system, CT, 996.1291 • Lymphatic system, radionuclide studies, 996.12963 • Mediastinum, neoplasms, 67.33
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J. H. Schouwink, L. Schultze Kool, E. J. Rutgers, F. A. N. Zoetmulder, N. van Zandwijk, M. J. v.d. Vijver, and P. Baas The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma Ann. Thorac. Surg., June 1, 2003; 75(6): 1715 - 1718. [Abstract] [Full Text] [PDF]
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M. K. Gould, G. D. Sanders, P. G. Barnett, C. E. Rydzak, C. C. Maclean, M. B. McClellan, and D. K. Owens Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med, May 6, 2003; 138(9): 724 - 735. [Abstract] [Full Text] [PDF]
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H. Stevens, P. F.A. Bakker, N. J.J. Schlosser, P. P. van Rijk, and J. M.H. de Klerk Use of a Dual-Head Coincidence Camera and 18F-FDG for Detection and Nodal Staging of Non-Small Cell Lung Cancer: Accuracy as Determined by 2 Independent Observers J. Nucl. Med., March 1, 2003; 44(3): 336 - 340. [Abstract] [Full Text] [PDF]
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C. Wittram, A. J. Fischman, E. Mark, J. Ko, and J.-A. O. Shepard Thymic Enlargement and FDG Uptake in Three Patients: CT and FDG Positron Emission Tomography Correlated with Pathology Am. J. Roentgenol., February 1, 2003; 180(2): 519 - 522. [Abstract] [Full Text] [PDF]
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T. P. Graeter, D. Hellwig, K. Hoffmann, D. Ukena, C.-M. Kirsch, and H.-J. Schafers Mediastinal lymph node staging in suspected lung cancer: comparison of positron emission tomography with F-18-fluorodeoxyglucose and mediastinoscopy Ann. Thorac. Surg., January 1, 2003; 75(1): 231 - 236. [Abstract] [Full Text] [PDF]
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E. V. Dizendorf, B. G. Baumert, G. K. von Schulthess, U. M. Lutolf, and H. C. Steinert Impact of Whole-Body 18F-FDG PET on Staging and Managing Patients for Radiation Therapy J. Nucl. Med., January 1, 2003; 44(1): 24 - 29. [Abstract] [Full Text] [PDF]
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G J Herder, H van Tinteren, E F Comans, O S Hoekstra, G J Teule, P E Postmus, U Joshi, and E F Smit Prospective use of serial questionnaires to evaluate the therapeutic efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected lung cancer Thorax, January 1, 2003; 58(1): 47 - 51. [Abstract] [Full Text] [PDF]
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S.G. Spiro Surgery for nonsmall cell lung cancer: can improvements be made? Eur. Respir. J., January 1, 2003; 21(39_suppl): 52S - 56s. [Abstract] [Full Text] [PDF]
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E. M. Toloza, L. Harpole, and D. C. McCrory Noninvasive Staging of Non-small Cell Lung Cancer: A Review of the Current Evidence Chest, January 1, 2003; 123(1_suppl): 137S - 146S. [Abstract] [Full Text] [PDF]
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S. G. Spiro and J. C. Porter Lung Cancer--Where Are We Today?: Current Advances in Staging and Nonsurgical Treatment Am. J. Respir. Crit. Care Med., November 1, 2002; 166(9): 1166 - 1196. [Abstract] [Full Text] [PDF]
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M. Nosotti, L. Santambrogio, M. Gasparini, A. Baisi, N. Bellaviti, and L. Rosso Role of 99mTc-Hexakis-2-Methoxy-Isobutylisonitrile in the Diagnosis and Staging of Lung Cancer Chest, October 1, 2002; 122(4): 1361 - 1364. [Abstract] [Full Text] [PDF]
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H. Vesselle, J. M. Pugsley, E. Vallieres, and D. E. Wood The impact of fluorodeoxyglucose F 18 positron-emission tomography on the surgical staging of non-small cell lung cancer J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 511 - 519. [Abstract] [Full Text] [PDF]
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M. A. Seltzer, C. S. Yap, D. H. Silverman, J. Meta, C. Schiepers, M. E. Phelps, S. S. Gambhir, J. Rao, P. E. Valk, and J. Czernin The Impact of PET on the Management of Lung Cancer: The Referring Physician's Perspective J. Nucl. Med., June 1, 2002; 43(6): 752 - 756. [Abstract] [Full Text] [PDF]
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N. Hollings and P. Shaw Diagnostic imaging of lung cancer Eur. Respir. J., April 1, 2002; 19(4): 722 - 742. [Abstract] [Full Text] [PDF]
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C.S. Brock and S.M. Lee Anti-angiogenic strategies and vascular targeting in the treatment of lung cancer Eur. Respir. J., March 1, 2002; 19(3): 557 - 570. [Abstract] [Full Text] [PDF]
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N. F. Esnaola, S. N. Lazarides, S. J. Mentzer, and K. M. Kuntz Outcomes and Cost-Effectiveness of Alternative Staging Strategies for Non-Small-Cell Lung Cancer J. Clin. Oncol., January 1, 2002; 20(1): 263 - 273. [Abstract] [Full Text] [PDF]
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K. Yamada, P. Kumar, and P. Goldstraw Cervical mediastinoscopy after total laryngectomy and radiotherapy: its feasibility Eur. J. Cardiothorac. Surg., January 1, 2002; 21(1): 71 - 73. [Abstract] [Full Text] [PDF]
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T. Akhurst, R. J. Downey, M. S. Ginsberg, M. Gonen, M. Bains, R. Korst, R. J. Ginsberg, V. W. Rusch, and S. M. Larson An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer Ann. Thorac. Surg., January 1, 2002; 73(1): 259 - 266. [Abstract] [Full Text] [PDF]
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G J M Herder, P Verboom, E F Smit, P C M van Velthoven, J H A M van den Bergh, C D Colder, I van Mansom, J C van Mourik, P E Postmus, G J J Teule, et al. Practice, efficacy and cost of staging suspected non-small cell lung cancer: a retrospective study in two Dutch hospitals Thorax, January 1, 2002; 57(1): 11 - 14. [Abstract] [Full Text] [PDF]
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R. J. Hicks, V. Kalff, M. P. MacManus, R. E. Ware, A. Hogg, A. F. McKenzie, J. P. Matthews, and D. L. Ball 18F-FDG PET Provides High-Impact and Powerful Prognostic Stratification in Staging Newly Diagnosed Non-Small Cell Lung Cancer J. Nucl. Med., November 1, 2001; 42(11): 1596 - 1604. [Abstract] [Full Text] [PDF]
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R. J. Hicks, V. Kalff, M. P. MacManus, R. E. Ware, A. F. McKenzie, J. P. Matthews, and D. L. Ball The Utility of 18F-FDG PET for Suspected Recurrent Non-Small Cell Lung Cancer After Potentially Curative Therapy: Impact on Management and Prognostic Stratification J. Nucl. Med., November 1, 2001; 42(11): 1605 - 1613. [Abstract] [Full Text] [PDF]
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G Laking and P Price 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer Thorax, September 1, 2001; 56(90002): ii38 - 44. [Full Text] [PDF]
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J.F. Vansteenkiste and S.G. Stroobants The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology Eur. Respir. J., April 1, 2001; 17(4): 802 - 820. [Abstract] [Full Text] [PDF]
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F. Tanaka, K. Yanagihara, Y. Otake, M. Li, R. Miyahara, H. Wada, and H. Ito Biological features and preoperative evaluation of mediastinal nodal status in non-small cell lung cancer Ann. Thorac. Surg., December 1, 2000; 70(6): 1832 - 1838. [Abstract] [Full Text] [PDF]
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P. F. Roberts, D. M. Follette, D. von Haag, J. A. Park, P. E. Valk, T. R. Pounds, and D. M. Hopkins Factors associated with false-positive staging of lung cancer by positron emission tomography Ann. Thorac. Surg., October 1, 2000; 70(4): 1154 - 1159. [Abstract] [Full Text] [PDF]
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C. Messa, C. Landoni, C. Pozzato, and F. Fazio Is There a Role for FDG PET in the Diagnosis of Musculoskeletal Neoplasms? J. Nucl. Med., October 1, 2000; 41(10): 1702 - 1702. [Full Text] [PDF]
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