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Meta-Analysis
. 2017 Mar 2;12(3):e0173104.
doi: 10.1371/journal.pone.0173104. eCollection 2017.

Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis

Guohua Shen  1 , You Lan  2 , Kan Zhang  2 , Pengwei Ren  3 , Zhiyun Jia  2
Affiliations
Meta-Analysis

Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis

Guohua Shen et al. PLoS One. .

Erratum in

Expression of concern in

Abstract

Background: Accurate clinical staging of mediastinal lymph nodes of patients with lung cancer is important in determining therapeutic options and prognoses. We aimed to compare the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting mediastinal nodal metastasis of lung cancer.

Methods: Relevant studies were systematically searched in the MEDLINE, EMBASE, PUBMED, and Cochrane Library databases. Based on extracted data, the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR) with individual 95% confidence intervals were calculated. In addition, the publication bias was assessed by Deek's funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses.

Results: Forty-three studies were finally included. For PET/CT, the pooled sensitivity and specificity were 0.65 (0.63-0.67) and 0.93 (0.93-0.94), respectively. The corresponding values of DWI were 0.72 (0.68-0.76) and 0.97 (0.96-0.98), respectively. The overall PLR and NLR of DWI were 13.15 (5.98-28.89) and 0.32 (0.27-0.39), respectively. For PET/CT, the corresponding values were 8.46 (6.54-10.96) and 0.38 (0.33-0.45), respectively. The Deek's test revealed no significant publication bias. Study design and patient enrollment were potential causes for the heterogeneity of DWI studies and the threshold was a potential source for PET/CT studies.

Conclusion: Both modalities are beneficial in detecting lymph nodes metastases in lung cancer without significant differences between them. DWI might be an alternative modality for evaluating nodal status of NSCLC.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of studies identified and included in the present meta-analysis.
Fig 2
Fig 2. Proportion of studies with low, high and unclear risks of bias and applicability concerns.
Review authors’ judgments about each domain presented as percentage across included studies.
Fig 3
Fig 3. Forest plot of sensitivity and specificity for DWI.
Each solid circle represents sensitivity and specificity of individual studies, and the size of the circle indicates the study size. The diamond means the pooled sensitivity and specificity of all 10 studies.
Fig 4
Fig 4. Forest plot of sensitivity and specificity for PET/CT.
Each solid circle represents sensitivity and specificity of individual studies, and the size of the circle indicates the study size. The diamond means the pooled sensitivity and specificity of all 38 studies.
Fig 5
Fig 5. SROC curve of DWI (A) and 18F-FDG PET/CT (B) in detecting mediastinal nodal metastases in patients with NSCLC.
Each x represents individual study estimates. The diamond is the summary point representing the average sensitivity and specificity estimates. The ellipses around this summary point are the 95% confidence region (dashed line) and the 95% prediction region (dotted line).
Fig 6
Fig 6. Funnel plot of publication bias for DWI (A) and 18F-FDG PET/CT (B).
Each circle represents individual study. The dashed line means the regression line.
See this image and copyright information in PMC

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