18F-FDG PET/CT based model for predicting malignancy in pulmonary nodules: a meta-analysis

Background Several studies to date have reported on the development of positron emission tomography (PET)/computed tomography (CT)-based models intended to effectively distinguish between benign and malignant pulmonary nodules (PNs). This meta-analysis was designed with the goal of clarifying the ut...

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Published in:Journal of cardiothoracic surgery 2024-03, Vol.19 (1), p.1-148, Article 148
Main Authors: Li, Yu, Shi, Yi-Bing, Hu, Chun-Feng
Format: Article
Language:English
Subjects:
Bias
Cancer
Computed tomography
CT imaging
Diagnosis
Differential diagnosis
Emission analysis
Heterogeneity
Lung nodules
Malignancy
Meta-analysis
Nodules
PET imaging
PET/CT
Positron emission
Positron emission tomography
Probability
Pulmonary nodule
Review
Sensitivity analysis
Tomography
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Summary:Background Several studies to date have reported on the development of positron emission tomography (PET)/computed tomography (CT)-based models intended to effectively distinguish between benign and malignant pulmonary nodules (PNs). This meta-analysis was designed with the goal of clarifying the utility of these PET/CT-based conventional parameter models as diagnostic tools in the context of the differential diagnosis of PNs. Methods Relevant studies published through September 2023 were identified by searching the Web of Science, PubMed, and Wanfang databases, after which Stata v 12.0 was used to conduct pooled analyses of the resultant data. Results This meta-analysis included a total of 13 retrospective studies that analyzed 1,731 and 693 malignant and benign PNs, respectively. The respective pooled sensitivity, specificity, PLR, and NLR values for the PET/CT-based studies developed in these models were 88% (95%CI: 0.86-0.91), 78% (95%CI: 0.71-0.85), 4.10 (95%CI: 2.98-5.64), and 0.15 (95%CI: 0.12-0.19). Of these endpoints, the pooled analyses of model sensitivity (I.sup.2 = 69.25%), specificity (I.sup.2 = 78.44%), PLR (I.sup.2 = 71.42%), and NLR (I.sup.2 = 67.18%) were all subject to significant heterogeneity. The overall area under the curve value (AUC) value for these models was 0.91 (95%CI: 0.88-0.93). When differential diagnosis was instead performed based on PET results only, the corresponding pooled sensitivity, specificity, PLR, and NLR values were 92% (95%CI: 0.85-0.96), 51% (95%CI: 0.37-0.66), 1.89 (95%CI: 1.36-2.62), and 0.16 (95%CI: 0.07-0.35), with all four being subject to significant heterogeneity (I.sup.2 = 88.08%, 82.63%, 80.19%, and 86.38%). The AUC for these pooled analyses was 0.82 (95%CI: 0.79-0.85). Conclusions These results suggest that PET/CT-based models may offer diagnostic performance superior to that of PET results alone when distinguishing between benign and malignant PNs. Keywords: PET/CT, Diagnosis, Pulmonary nodule, Meta-analysis
ISSN:1749-8090
1749-8090
DOI:10.1186/s13019-024-02614-0