Imaging for the Pretreatment Staging of Small cell Lung Cancer: A Systematic Review.
Small cell lung cancer (SCLC) is an aggressive form of lung cancer. Accurate staging is essential to select the optimal treatment plan to maximize survival. No consensus exists on standard imaging modalities for pretreatment staging of SCLC.



We conducted a systematic review of the literature on imaging modalities in the pretreatment staging of SCLC. A systematic search of multiple databases identified relevant studies published from 2000 through June 2015. Outcomes of interest included test concordance, staging accuracy (sensitivity and specificity), choice of treatment, timeliness of treatment, and patient outcomes.



The search identified 2880 citations; 7 studies met inclusion criteria, n = 408 patients. Six of the seven studies were deemed to have moderate risk of bias, and one was deemed to have high risk of bias. One of the studies reported test concordance, three studies reported comparative accuracy of testing strategies, and four studies reported the accuracy of a single imaging modality. Analysis from these studies revealed that fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is more sensitive than multidetector CT for detecting osseous metastases, more sensitive than bone scintigraphy for detecting osseous metastases, and more sensitive for detecting any distant metastases.



Evidence is sparse on the use of imaging in the pretreatment staging of SCLC. There is a lack of evidence on patient-oriented outcomes and a lack of evidence on whether comparative accuracy or effectiveness is associated with patient factors. We found low-strength evidence suggesting that FDG-PET/CT is more sensitive than CT and bone scintigraphy for detecting osseous metastases.
Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St., Suite 50, Philadelphia, PA 19104; ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania. Electronic address: mdmitchell@uphs.upenn.edu.
Matthew D
MD
Mitchell
Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Charu
C
Aggarwal
ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania; ECRI Institute, Plymouth Meeting, Pennsylvania.
Amy Y
AY
Tsou
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Drew A
DA
Torigian
ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania; ECRI Institute, Plymouth Meeting, Pennsylvania.
Jonathan R
JR
Treadwell
D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*
Small cell lung cancer (SCLC); computed tomography (CT); magnetic resonance imaging (MRI); neoplasm staging, positron emission tomography/computed tomography (PET/CT)