title: Diagnostic accuracy of 18F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review and meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the differential diagnosis between malignant and benign pleural lesions.
  
  
  METHODS
  A comprehensive literature search of studies published through June 2013 regarding the diagnostic performance of (18)F-FDG-PET and PET/CT in the differential diagnosis of pleural lesions was carried out. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) of (18)F-FDG-PET or PET/CT in the differential diagnosis of pleural lesions on a per-patient-based analysis were calculated. The area under the summary receiver operating characteristic curve (AUC) was calculated to measure the accuracy of these methods. Subanalyses considering device used (PET or PET/CT) were performed.
  
  
  RESULTS
  Sixteen studies including 745 patients were included in the systematic review. The meta-analysis of 11 selected studies provided the following results: sensitivity 95% (95% confidence interval [95%CI]: 92-97%), specificity 82% (95%CI: 76-88%), LR+ 5.3 (95%CI: 2.4-11.8), LR- 0.09 (95%CI: 0.05-0.14), DOR 74 (95%CI: 34-161). The AUC was 0.95. No significant improvement of the diagnostic accuracy considering PET/CT studies only was found.
  
  
  CONCLUSIONS
  (18)F-FDG-PET and PET/CT demonstrated to be accurate diagnostic imaging methods in the differential diagnosis between malignant and benign pleural lesions; nevertheless, possible sources of false-negative and false-positive results should be kept in mind.
authors: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, via Ospedale, 12; 6500; Bellinzona, Switzerland. Electronic address: giorgiomednuc@libero.it.
authors: Giorgio
authors: G
authors: Treglia
authors: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Ramin
authors: R
authors: Sadeghi
authors: Institute of Nuclear Medicine, Catholic University, Rome, Italy.
authors: Salvatore
authors: S
authors: Annunziata
authors: Unit of Thoracic Surgery, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors: Filippo
authors: F
authors: Lococo
authors: Thoracic Surgery, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
authors: Stefano
authors: S
authors: Cafarotti
authors: Chair of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy.
authors: Francesco
authors: F
authors: Bertagna
authors: Nuclear Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: John O
authors: JO
authors: Prior
authors: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, via Ospedale, 12; 6500; Bellinzona, Switzerland.
authors: Luca
authors: L
authors: Ceriani
authors: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, via Ospedale, 12; 6500; Bellinzona, Switzerland.
authors: Luca
authors: L
authors: Giovanella
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D010995:Pleural Diseases / Q000175:diagnosis; D010997:Pleural Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: PET/CT; Positron emission tomography; differential diagnosis; pleura; pleural lesions