title: Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: a systematic review and a meta-analysis.
abstract: OBJECTIVE
  To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the assessment of pleural abnormalities in cancer patients.
  
  
  METHODS
  A comprehensive literature search of studies published through June 2013 regarding the role of (18)F-FDG-PET and PET/CT in evaluating pleural abnormalities in cancer patients was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odd ratio (DOR) of (18)F-FDG-PET or PET/CT on a per patient-based analysis were calculated. The area under the summary ROC curve (AUC) was calculated to measure the accuracy of these methods in the assessment of pleural abnormalities. Sub-analyses considering (18)F-FDG-PET/CT and patients with lung cancer only were carried out.
  
  
  RESULTS
  Eight studies comprising 360 cancer patients (323 with lung cancer) were included. The meta-analysis of these selected studies provided the following results: sensitivity 86% [95% confidence interval (95%CI): 80-91%], specificity 80% [95%CI: 73-85%], LR+ 3.7 [95%CI: 2.8-4.9], LR- 0.18 [95%CI: 0.09-0.34], DOR 27 [95%CI: 13-56]. The AUC was 0.907. No significant improvement considering PET/CT studies only and patients with lung cancer was found.
  
  
  CONCLUSIONS
  (18)F-FDG-PET and PET/CT demonstrated to be useful diagnostic imaging methods in the assessment of pleural abnormalities in cancer patients, nevertheless possible sources of false-negative and false-positive results should be kept in mind. The literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited and prospective studies are needed.
authors.affiliation: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. Electronic address: giorgiomednuc@libero.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Sadeghi
authors.affiliation: Institute of Nuclear Medicine, Catholic University, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Annunziata
authors.affiliation: Unit of Thoracic Surgery, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: Thoracic Surgery, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cafarotti
authors.affiliation: Department of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: John O
authors.initials: JO
authors.lastname: Prior
authors.affiliation: Chair of Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bertagna
authors.affiliation: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Ceriani
authors.affiliation: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Giovanella
mesh_terms: D000818:Animals; D003951:Diagnostic Errors; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D064847:Multimodal Imaging; D010994:Pleura / Q000000981:diagnostic imaging* / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: (18)F-FDG; Lung cancer; PET/CT; Pleura; Pleural effusion; Positron emission tomography