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(Radiology. 1999;213:530-536.)
© RSNA, 1999

Nuclear Medicine

Metastases from Non-Small Cell Lung Cancer: Mediastinal Staging in the 1990s-Meta-analytic Comparison Of PET and CT1

Ben A. Dwamena, MB, ChB, Seema S. Sonnad, PhD, Jeff O. Angobaldo, MS and Richard L. Wahl, MD

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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