The value of 18 F-FDG-PET/CT in the diagnosis of solitary pulmonary nodules: A meta-analysis

Abstract

Background: Solitary pulmonary nodules (SPNs) are common imaging findings. Many studies have indicated that 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) is an accurate test for distinguishing benign and malignant SPNs. The aim of this study was to investigate the value of 18 F-FDG-PET/CT in the diagnosis of malignant SPNs. Methods: We systematically searched the PubMed and Embase databases up to March 2017, and published data on sensitivity, specificity, and other measures of diagnostic accuracy of 18 F-FDG-PET/CT in the diagnosis of malignant SPNs were meta-analyzed. Statistical analyses were undertaken using Meta-DiSc 1.4 software and Stata version 12.0. The measures of accuracy of 18 F-FDG-PET/CT in the diagnosis of malignant SPNs were pooled using random-effects models. Results: A total of 20 publications reporting 21 studies were identified. Pooled results indicated that 18 F-FDG-PET/CT showed a diagnostic sensitivity of 0.89 (95% confidence interval [CI], 0.87-0.91) and a specificity of 0.70 (95% CI, 0.66-0.73). The positive likelihood ratio was 3.33 (95% CI, 2.35-4.71) and the negative likelihood ratio was 0.18 (95% CI, 0.13-0.25). The diagnostic odds ratio was 22.43 (95% CI, 12.55-40.07). Conclusions: 18 F-FDG-PET/CT showed insufficient sensitivity and specificity for diagnosing malignant SPNs; it cannot replace the "gold standard" pathology by resection or percutaneous biopsy. Larger studies are required for further evaluation.