title: Meta-analysis: comparison of F-18 fluorodeoxyglucose-positron emission tomography and bone scintigraphy in the detection of bone metastasis in patients with lung cancer.
abstract: OBJECTIVE
  The aim of this review was to evaluate the diagnostic properties of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (CT) and bone scintigraphy in the detection of osseous metastases in patients with lung cancer.
  
  
  METHODS
  MEDLINE was searched for relevant original articles published between January 1995 and August 2010. Inclusion criteria were as follows: FDG-PET or PET/CT and bone scintigraphy was carried out to detect bone metastases in patients with lung cancer, sufficient data were presented to construct a 2 × 2 contingency table, and histopathologic analysis and/or close clinical and imaging follow-up and/or radiographic confirmation by multiple imaging modalities was used as the reference standard. Two reviewers independently extracted data related to research design, sample size, imaging techniques, technical characteristics, reference standards, methods of imaging interpretation, and totals of true-positives, false-positives, true-negatives, and false-negatives. Stata was used to obtain per patient and per lesion pooled estimates of sensitivity, specificity, and positive and negative likelihood ratios, and areas under summary receiver-operating characteristic curves (AUCs) were calculated.
  
  
  RESULTS
  The pooled patient-based sensitivity of FDG-PET or PET/CT was 0.93 (95% confidence interval [CI], 0.88-0.96), specificity was 0.95 (95% CI, 0.91-0.98), and the AUC was 0.94. The pooled sensitivity of bone scans was 0.87 (95% CI, 0.79-0.93), specificity was 0.82 (95% CI, 0.62-0.92), and the AUC was 0.91. The pooled lesion-based sensitivity of FDG-PET or PET/CT was 0.93 (95% CI, 0.84-0.97), specificity was 0.91 (95% CI, 0.80-0.96), and the AUC was 0.97. The pooled sensitivity of bone scans was 0.92 (95% CI, 0.87-0.95), specificity was 0.57 (95% CI, 0.09-0.95), and the AUC was 0.92.
  
  
  CONCLUSIONS
  Although FDG-PET or PET/CT has higher sensitivity and specificity than bone scintigraphy, further research with a less biased design is needed to determine the most efficacious imaging modality for the detection of metastatic lung cancer.
authors.affiliation: Nuclear Medicine Department, Changhua Christian Hospital, Taiwan.
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Chang
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Chen
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Kuang-Tao
authors.initials: KT
authors.lastname: Yang
authors.forename: Kai-Yuan
authors.initials: KY
authors.lastname: Cheng
authors.forename: Jun-Jun
authors.initials: JJ
authors.lastname: Yeh
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18