Diagnostic value of 18F-FDG-PET/CT for the evaluation of solitary pulmonary nodules: A systematic review and meta-analysis

Abstract

Objectives To carry out a meta-analysis on the performance of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/computed tomography (PET/CT) for the evaluation of solitary pulmonary nodules. Materials and methods In the meta-analysis, we performed searches of several electronic databases for relevant studies, including Google Scholar, PubMed, Cochrane Library, and several Chinese databases. The quality of all included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Two observers independently extracted data of eligible articles. For the meta-analysis, the total sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were pooled. A summary receiver operating characteristic curve was constructed. The I2-test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Metaregression and subgroup analysis were carried out to investigate the potential covariates that might have considerable impacts on heterogeneity. Results Overall, 12 studies were included in this metaanalysis, including a total of 1297 patients and 1301 pulmonary nodules. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with corresponding 95% confidence intervals (CIs) were 0.82 (95% CI, 0.76-0.87), 0.81 (95% CI, 0.66-0.90), 4.3 (95% CI, 2.3-7.9), and 0.22 (95% CI, 0.16-0.30), respectively. Significant heterogeneity was observed in sensitivity (I2=81.1%) and specificity (I2=89.6%). Subgroup analysis showed that the best results for sensitivity (0.90; 95% CI, 0.68-0.86) and accuracy (0.93; 95% CI, 0.90-0.95) were present in a prospective study. Conclusion The results of our analysis suggest that PET/ CT is a useful tool for detecting malignant pulmonary nodules qualitatively. Although current evidence showed moderate accuracy for PET/CT in differentiating malignant from benign solitary pulmonary nodules, further work needs to be carried out to improve its reliability.