Abstract
BackgroundTo compare the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the N stage assessment in patients with non–small-cell lung cancer. MethodsWe performed a meta-analysis of all available studies of the diagnostic performance of DWI and 18F-FDG PET/CT in the N stage assessment of patients with non–small-cell lung cancer. We determined the sensitivity and specificity across studies, calculated the positive and negative likelihood ratios (LR+ and LR−, respectively), and constructed the summary receiver operating characteristic curves using hierarchical regression models. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. ResultsA total of 19 studies met the inclusion criteria and included a total of 2845 pathologically confirmed patients. No publication bias was found. The methodologic quality was relatively high. The pooled sensitivity estimate of DWI (0.72, 95% confidence interval [CI] 0.63–0.80) was not significantly difference between PET/CT (0.75, 95% CI 0.68–0.81; P = 0.09). The pooled specificity estimate for DWI (0.95, 95% CI 0.85–0.98) was significantly greater than 18F-FDG PET/CT (0.89, 95% CI 0.85–0.91; P = 0.02). For DWI, the overall LR+ was 13.80 (95% CI 4.54–41.95) and the LR− was 0.29 (95% CI 0.21–0.40). For 18F-FDG PET/CT, LR+ was 6.67 (95% CI 5.20–8.56) and LR− was 0.28 (95% CI 0.22–0.37). ConclusionsOur study has confirmed that DWI has a high specificity for N staging of non–small-cell lung cancer compared with 18F-FDG PET/CT and has the potential to be a reliable alternative noninvasive imaging method for the preoperative staging of mediastinal and hilar lymph nodes in patients with non–small-cell lung cancer.
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