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. 2022 Apr 29:12:871827.
doi: 10.3389/fonc.2022.871827. eCollection 2022.

Differential Diagnostic Value of Histology in MPLC and IPM: A Systematic Review and Meta-Analysis

Sen Tian  1 , Fuqi Li  1   2 , Jin Pu  3 , Yi Zheng  4 , Hui Shi  1 , Yuchao Dong  1 , Ruohua Chen  3 , Chong Bai  1
Affiliations

Differential Diagnostic Value of Histology in MPLC and IPM: A Systematic Review and Meta-Analysis

Sen Tian et al. Front Oncol. .

Abstract

Background: The paramount issue regarding multiple lung cancer (MLC) is whether it represents multiple primary lung cancer (MPLC) or intrapulmonary metastasis (IPM), as this directly affects both accurate staging and subsequent clinical management. As a classic method, histology has been widely utilized in clinical practice. However, studies examining the clinical value of histology in MLC have yielded inconsistent results; thus, this remains to be evaluated. Here, we performed a meta-analysis to assess the differential diagnostic value of histology in MPLC and IPM and to provide evidence-based medicine for clinical work.

Methods: PubMed, Embase, and Web of Science databases were searched to collect relevant literature according to PRISMA, and inclusion and exclusion criteria were set up to screen and assess the literature. The data required for reconstructing a 2 × 2 contingency table were extracted directly or calculated indirectly from the included studies, and statistical analysis was carried out by using Stata 15, Meta-DiSc 1.4, and Review Manager 5.4 software.

Results: A total of 34 studies including 1,075 pairs of tumors were included in this meta-analysis. Among these studies, 11 were about the M-M standard and the pooled sensitivity and specificity were 0.78 (95% CI: 0.71-0.84) and 0.47 (95% CI: 0.38-0.55), respectively; 20 studies were about CHA and the pooled sensitivity and specificity were 0.76 (95% CI: 0.72-0.80) and 0.74 (95% CI: 0.68-0.79), respectively; and 3 studies were about the "CHA & Lepidic" criteria and the pooled sensitivity and specificity were 0.96 (95% CI: 0.85-0.99) and 0.47 (95% CI: 0.21-0.73), respectively. The combined pooled sensitivity, specificity, PLR, NLR, DOR, and the area under the SROC curve of the 34 studies were 0.80 (95% CI: 0.73-0.86), 0.64 (95% CI: 0.51-0.76), 2.25 (95% CI: 1.59-3.17), 0.31 (95% CI: 0.23-0.43), 7.22 (95% CI: 4.06-12.81), and 0.81 (95% CI: 0.77-0.84), respectively.

Conclusion: The current evidence indicated that histology had a moderate differential diagnostic value between MPLC and IPM. Among the three subgroups, the "CHA & Lepidic" criteria showed the highest sensitivity and CHA showed the highest specificity. Further research is necessary to validate these findings and to improve clinical credibility.

Systematic review registration: PROSPERO, identifier CRD42022298180.

Keywords: histology; intrapulmonary metastasis; meta-analysis; molecular; multiple primary lung cancer.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The PRISMA flow diagram of the selected eligible studies.
Figure 2
Figure 2
Quality of the selected studies according to the QUADAS-2 guidelines. (A) Risk of bias graph. (B) Risk of summary.
Figure 3
Figure 3
Forest plots of sensitivities and specificities for histology in the differential diagnosis of multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM).
Figure 4
Figure 4
The ROC plane for assessing threshold effects.
Figure 5
Figure 5
Forest plots of consistency for each histological method in the differential diagnosis of MPLC and IPM.
Figure 6
Figure 6
Forest plots of PLR and NLR for histology in the differential diagnosis of MPLC and IPM.
Figure 7
Figure 7
Forest plots of the diagnostic score and DOR for histology in the differential diagnosis of MPLC and IPM.
Figure 8
Figure 8
The SROC curve of the differential diagnostic value of histology in MPLC and IPM.
Figure 9
Figure 9
Fagan’s nomogram for likelihood ratios.
Figure 10
Figure 10
The likelihood ratio scattergram.
Figure 11
Figure 11
The HSROC curve of the differential diagnostic value of histology in MPLC and IPM.
Figure 12
Figure 12
The result of Deeks’ funnel test.
See this image and copyright information in PMC

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