title: Solitary pulmonary nodules and masses: a meta-analysis of the diagnostic utility of alternative imaging tests.
abstract: The purpose was to assess the clinical utility of diagnostic tests for identifying malignancy within a solitary pulmonary nodule (SPN), and to create a nomogram or "look-up" table using clinical data and non-invasive radiology (positive) test results to estimate post-test probability of malignancy. Studies that examined computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) for the evaluation of SPN. Two reviewers independently abstracted data and assessed study quality. Study-specific and overall positive likelihood ratios (LRs) for each diagnostic test confirming a diagnosis of malignancy and negative LR for each diagnostic test excluding a diagnosis of malignancy within an SPN were calculated. Forty-four of 242 articles were included. Positive LRs for diagnostic tests were: CT 3.91 (95% confidence interval 2.42, 5.40), MRI 4.57 (3.03, 6.1), PET 5.44 (3.56, 7.32) and SPECT 5.16 (4.03, 6.30). Negative LRs were: CT 0.10 (0.03, 0.16), MRI 0.08 (0.03, 0.12), PET 0.06 (0.02, 0.09) and SPECT 0.06 (0.04, 0.08). Differences in performance for all tests were negligible; therefore, the clinician may confidently use any of the four tests presented in further evaluating an SPN. Given the low cost and prevalence of the technology, SPECT appears to be the leading choice for additional testing in SPN evaluation.
authors.affiliation: Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, B1 132F Taubman Center/0302, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0030, USA. pcronin@med.umich.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Cronin
authors.forename: Ben A
authors.initials: BA
authors.lastname: Dwamena
authors.forename: Aine Marie
authors.initials: AM
authors.lastname: Kelly
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Carlos
mesh_terms: D000465:Algorithms; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008175:Lung Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*