Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography or Positron Emission Tomography/Computed Tomography for Assessment of Occult Lymph Node Metastasis in Non-Small Cell Lung Cancer

Abstract

Objective: The purpose of the current study was to investigate the diagnostic performance of ¹⁸F fluorodeoxyglucose (FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) for the prediction of occult lymph node metastasis (OLNM) in non-small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis. Methods: The PubMed, Cochrane, and EMBASE database, from the earliest available date of indexing through March 31, 2020, were searched for studies evaluating the diagnostic performance of preoperative ¹⁸F FDG PET or PET/CT for the prediction of OLNM in NSCLC patients. Results: Across 14 studies (3,535 patients), the pooled sensitivity for ¹⁸F FDG PET or PET/CT was 0.79 (95% CI; 0.70–0.86) with heterogeneity (I² = 81.5, p < 0.001) and a pooled specificity of 0.65 (95% CI; 0.57–0.72) with heterogeneity (I² = 93.7, p < 0.001). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 2.3 (95% CI; 1.9–2.6) and a negative likelihood ratio (LR-) of 0.32 (95% CI; 0.23–0.44). The pooled diagnostic odds ratio (DOR) was 7 (95% CI; 5–10). The hierarchical summary receiver operating characteristic curve indicates that the area under the curve was 0.77 (95% CI; 0.74–0.81). Conclusion: The current meta-analysis showed a moderate sensitivity and specificity of ¹⁸F FDG PET or PET/CT for the prediction of OLNM in NSCLC patients. The DOR was low and the likelihood ratio scatter-gram indicated that ¹⁸F FDG PET or PET/CT might not be useful for the prediction of OLNM in NSCLC patients and not for its exclusion.