Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT.
OBJECTIVE
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.


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.


CONCLUSIONS
PET is superior to CT for mediastinal staging of non-small cell lung cancer, independent of performance index or clinical context of PET imaging.
Dwamena
B A
BA
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028, USA.
Sonnad
S S
SS
Angobaldo
J O
JO
Wahl
R L
RL
D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000556:secondary; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008482:Mediastinum; D009367:Neoplasm Staging; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed