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

Authors: Giorgio Treglia, Ramin Sadeghi, MD, Salvatore Annunziata, MD, Filippo Lococo, MD, Stefano Cafarotti, MD, Francesco Bertagna, MD, John O. Prior, MD, Luca Ceriani, MD, Luca Giovanella, MD


Rationale and Objectives

To systematically review and meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the differential diagnosis between malignant and benign pleural lesions.



Methods and Materials


A comprehensive literature search of studies published through June 2013 regarding the diagnostic performance of 18F-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 18F-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

18F-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.