Comparison of the diagnostic performance of 18F-fluorothymidine versus 18F-fluorodeoxyglucose positron emission tomography on pulmonary lesions: A meta analysis.

Abstract

A pulmonary lesion is an extremely common and clinically challenging disorder worldwide, and an accurate diagnosis of lung cancer is crucial for early treatment and management. The aim of the present study was to perform a comprehensive meta analysis to compare the diagnostic performance of 18F-fluorothymidine (18F-FLT) positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) PET in evaluating patients with pulmonary lesions. Relevant studies were identified using the PubMed, EMBASE and Cochrane library databases. The pooled estimated sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and diagnostic odds ratio (DOR) for 18F-FLT PET versus 18F-FDG PET were calculated as the main outcome measures. Summary receiver operating characteristic curves were also constructed by Meta-Disk 1.4 software using a Mose's constant of linear model. The meta analysis showed that 18F-FLT PET had a higher specificity (0.70; 95% CI, 0.61-0.77), but lower sensitivity (0.81; 95% CI, 0.74-0.87) compared to 18F-FDG PET (0.50; 95% CI, 0.41-0.58 for specificity; 0.92; 95% CI 0.86-0.95 for sensitivity). For DOR, 18F-FLT PET (12.58; 95% CI, 6.81-23.24) was higher compared to 18F-FDG PET (10.72; 95% CI, 5.51-20.87). The area under the curve was 0.8592 and 0.9240 for 18F-FLT PET and 18F-FDG PET, respectively (Z=0.976, P>0.05). In conclusion, 18F-FLT PET and 18F-FDG PET had good diagnostic performance for the overall assessment of pulmonary lesions, and 18F-FLT PET had a higher specificity compared to 18F-FDG PET, but was less sensitive than 18F-FDG PET. Therefore, 18F-FLT and 18F-FDG together could add diagnostic confidence for pulmonary lesions.