title: Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
abstract: OBJECTIVE
  Positron emission tomography (PET) combined with fludeoxyglucose F 18 (FDG) is recommended for the noninvasive diagnosis of pulmonary nodules suspicious for lung cancer. In populations with endemic infectious lung disease, FDG-PET may not accurately identify malignant lesions.
  
  
  OBJECTIVE
  To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the test accuracy in regions where infectious lung disease is rare.
  
  
  METHODS
  Databases of MEDLINE, EMBASE, and the Web of Science were searched from October 1, 2000, through April 28, 2014. Articles reporting information sufficient to calculate sensitivity and specificity of FDG-PET to diagnose lung cancer were included. Only studies that enrolled more than 10 participants with benign and malignant lesions were included. Database searches yielded 1923 articles, of which 257 were assessed for eligibility. Seventy studies were included in the analysis. Studies reported on a total of 8511 nodules; 5105 (60%) were malignant.
  
  
  METHODS
  Abstracts meeting eligibility criteria were collected by a research librarian and reviewed by 2 independent reviewers. Hierarchical summary receiver operating characteristic curves were constructed. A random-effects logistic regression model was used to summarize and assess the effect of endemic infectious lung disease on test performance.
  
  
  METHODS
  The sensitivity and specificity for FDG-PET test performance.
  
  
  RESULTS
  Heterogeneity for sensitivity (I2 = 87%) and specificity (I2 = 82%) was observed across studies. The pooled (unadjusted) sensitivity was 89% (95% CI, 86%-91%) and specificity was 75% (95% CI, 71%-79%). There was a 16% lower average adjusted specificity in regions with endemic infectious lung disease (61% [95% CI, 49%-72%]) compared with nonendemic regions (77% [95% CI, 73%-80%]). Lower specificity was observed when the analysis was limited to rigorously conducted and well-controlled studies. In general, sensitivity did not change appreciably by endemic infection status, even after adjusting for relevant factors.
  
  
  CONCLUSIONS
  The accuracy of FDG-PET for diagnosing lung nodules was extremely heterogeneous. Use of FDG-PET combined with computed tomography was less specific in diagnosing malignancy in populations with endemic infectious lung disease compared with nonendemic regions. These data do not support the use of FDG-PET to diagnose lung cancer in endemic regions unless an institution achieves test performance accuracy similar to that found in nonendemic regions.
authors.affiliation: Veterans Affairs Hospital, Tennessee Valley Healthcare System, Nashville2Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Deppen
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Blume
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Clark D
authors.initials: CD
authors.lastname: Kensinger
authors.affiliation: School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Morgan
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee6Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Aldrich
authors.affiliation: Veterans Affairs Hospital, Tennessee Valley Healthcare System, Nashville7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Massion
authors.affiliation: Department of Medical Imaging, Tennessee Valley Healthcare System-Veterans Affairs, Nashville9Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Walker
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee10Division of Obstetrics and Gynecology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McPheeters
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.affiliation: Veterans Affairs Hospital, Tennessee Valley Healthcare System, Nashville2Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Grogan
mesh_terms: D003937:Diagnosis, Differential; D019353:Endemic Diseases; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007239:Infections / Q000000981:diagnostic imaging / Q000453:epidemiology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18