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Systematic Review and Meta-Analysis of 2-[18F]Fluoro-2-Deoxy-d-Glucose PET-CT Imaging for Nodal Staging of Part-Solid
Pui Man Choy1, Ho Yin Arnold Wong2, Eric Kian Saik Lim3
1Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, England.
Background:
Lung adenocarcinoma is the most prevalent subtype of lung cancer. When presenting as ground-glass or part-solid nodules, lung adenocarcinomas typically show slow growth, rarely metastasize, and have low 2-[18F]fluoro-2-deoxy-d-glucose (FDG) avidity. Retrospective evidence demonstrated limited value of FDG PET-CT scan staging in T1 part-solid lung cancers. The National Institute for Health and Care Excellence recommends FDG PET-CT imaging to confirm localized disease in patients eligible for radical treatment.
Research Question:
To carry out a systematic review to establish the diagnostic accuracy of FDG PET-CT imaging for nodal staging in T1 part-solid lung cancers.
Study Design And Methods:
A systematic search was conducted using the PICO (population, intervention, comparison, outcome) framework. Predefined inclusion and exclusion criteria were applied. Relevant data were extracted, and risk of bias was assessed using the QUADAS-2 tool. Sensitivity and specificity of FDG PET-CT imaging for nodal staging in T1 part-solid lung cancers were pooled, presented in forest plots and as an HSROC curve, and compared with the diagnostic performance of CT imaging of the thorax. The association between total nodule size and nodal staging was explored.
Results:
Nodal metastases were rare, with 6 studies reporting 0% nodal involvement. Diagnostic performance metrics for FDG PET-CT imaging were available in 4 studies, which showed low sensitivity (28%), high specificity (90%), and poor accuracy (0.599). In 2 studies comparing CT and FDG PET-CT imaging, no significant difference in sensitivity was observed (sensitivity: CT imaging, 12%; FDG PET-CT imaging, 29%; P = .320), whereas CT imaging demonstrated higher specificity (specificity: CT imaging, 97%; FDG PET-CT imaging, 83%; P < .001). In addition, no nodal metastases were reported in nodules with a total size ≤ 10 mm in 2 studies.
Interpretation:
Our results show that FDG PET-CT imaging has limited diagnostic value for nodal staging in part-solid lung cancers, particularly for small nodules (total size ≤ 10 mm, T1a), where nodal metastasis was not observed. Although sensitivity did not differ between CT and FDG PET-CT imaging, CT imaging provided higher specificity.
Clinical Trial Registration:
PROSPERO; No.: CRD420251135365; URL: www.crd.york.ac.uk/PROSPERO/.
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