title: Preoperative mediastinal and hilar nodal staging with diffusion-weighted magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography in patients with non-small-cell lung cancer: which is better?
abstract: BACKGROUND
  To compare the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) and (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the N stage assessment in patients with non-small-cell lung cancer.
  
  
  METHODS
  We performed a meta-analysis of all available studies of the diagnostic performance of DWI and (18)F-FDG PET/CT in the N stage assessment of patients with non-small-cell lung cancer. We determined the sensitivity and specificity across studies, calculated the positive and negative likelihood ratios (LR+ and LR-, respectively), and constructed the summary receiver operating characteristic curves using hierarchical regression models. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.
  
  
  RESULTS
  A total of 19 studies met the inclusion criteria and included a total of 2845 pathologically confirmed patients. No publication bias was found. The methodologic quality was relatively high. The pooled sensitivity estimate of DWI (0.72, 95% confidence interval [CI] 0.63-0.80) was not significantly difference between PET/CT (0.75, 95% CI 0.68-0.81; P = 0.09). The pooled specificity estimate for DWI (0.95, 95% CI 0.85-0.98) was significantly greater than (18)F-FDG PET/CT (0.89, 95% CI 0.85-0.91; P = 0.02). For DWI, the overall LR+ was 13.80 (95% CI 4.54-41.95) and the LR- was 0.29 (95% CI 0.21-0.40). For (18)F-FDG PET/CT, LR+ was 6.67 (95% CI 5.20-8.56) and LR- was 0.28 (95% CI 0.22-0.37).
  
  
  CONCLUSIONS
  Our study has confirmed that DWI has a high specificity for N staging of non-small-cell lung cancer compared with (18)F-FDG PET/CT and has the potential to be a reliable alternative noninvasive imaging method for the preoperative staging of mediastinal and hilar lymph nodes in patients with non-small-cell lung cancer.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lian-Ming
authors.initials: LM
authors.lastname: Wu
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Xu
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Gu
authors.forename: Jia
authors.initials: J
authors.lastname: Hua
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: E Mark
authors.initials: EM
authors.lastname: Haacke
authors.forename: Jiani
authors.initials: J
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods / Q000592:standards; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards*; D049268:Positron-Emission Tomography; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18