Can 18F-FDG PET/CT predict EGFR status in patients with non-small cell lung cancer? A systematic review and meta-analysis

Abstract

Objectives: This study aimed to explore the diagnostic significance of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT for predicting the presence of epidermal growth factor receptor (EGFR) mutations in patients with non-small cell lung cancer (NSCLC).

Design: A systematic review and meta-analysis.

Data sources: The PubMed, EMBASE and Cochrane library databases were searched from the earliest available date to December 2020.

Eligibility criteria for selecting studies: The review included primary studies that compared the mean maximum of standard uptake value (SUV_max) between wild-type and mutant EGFR, and evaluated the diagnostic value of ¹⁸F-FDG PET/CT using SUV_max for prediction of EGFR status in patients with NSCLC.

Data extraction and synthesis: The main analysis was to assess the sensitivity and specificity, the positive diagnostic likelihood ratio (DLR+) and DLR-, as well as the diagnostic OR (DOR) of SUV_max in prediction of EGFR mutations. Each data point of the summary receiver operator characteristic (SROC) graph was derived from a separate study. A random effects model was used for statistical analysis of the data, and then diagnostic performance for prediction was further assessed.

Results: Across 15 studies (3574 patients), the pooled sensitivity for ¹⁸F-FDG PET/CT was 0.70 (95% CI 0.60 to 0.79) with a pooled specificity of 0.59 (95% CI 0.52 to 0.66). The overall DLR+ was 1.74 (95% CI 1.49 to 2.03) and DLR- was 0.50 (95% CI 0.38 to 0.65). The pooled DOR was 3.50 (95% CI 2.37 to 5.17). The area under the SROC curve was 0.68 (95% CI 0.64 to 0.72). The likelihood ratio scatter plot based on average sensitivity and specificity was in the lower right quadrant.

Conclusion: Meta-analysis results showed ¹⁸F-FDG PET/CT had low pooled sensitivity and specificity. The low DOR and the likelihood ratio scatter plot indicated that ¹⁸F-FDG PET/CT should be used with caution when predicting EGFR mutations in patients with NSCLC.

Keywords: genetics; nuclear radiology; respiratory tract tumours.

Figure 1

Publication screening flowchart. DOR, diagnostic OR; WMD, weighted mean difference.

Figure 2

Forest plot for analysis of ¹⁸F-fluorodeoxyglucose uptake in epidermal growth factor receptor mutant versus wild-type in patients with non-small cell lung cancer. WMD, weighted mean difference.

Figure 3

(A) Risk of bias of included studies.(B) Funnel plot of maximum of standard uptake value in epidermal growth factor receptor mutant versus wild-type in patients with non-small cell lung cancer. WMD, weighted mean difference.

Figure 4

(A) Assessment of risk of bias of the included studies using QUADAS-2 tool. (B) Deeks’s funnel plot of asymmetry test for publication bias showed no significant bias was found. ESS, effective sample size; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2; WMD, weighted mean difference.

Figure 5

Forest plot of pooled sensitivity and specificity of ¹⁸F-fluorodeoxyglucose positron emission tomography/CT for predicting epidermal growth factor receptor mutations in patients with non-small cell lung cancer.

Figure 6

Forest plot of pooled positive, negative diagnostic likelihood ratio (DLR) and diagnostic OR of ¹⁸F-fluorodeoxyglucose emission tomography/CT for predicting epidermal growth factor receptor mutations in patients with non-small cell lung cancer.

Figure 7

(A) Summary receiver operating characteristic (SROC) curves of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT for predicting epidermal growth factor receptor (EGFR) mutations in patients with non-small cell lung cancer (NSCLC). (B) Likelihood ratio scatter plot of ¹⁸F-FDG PET/CT predicting EGFR mutations in patients with NSCLC. AUC, area under curve.