Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 nonsmall-cell lung cancer: A meta-analysis

Jingbo Wang, Kathy Welch, Luhua Wang, Feng Ming Spring Kong

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: Nodal staging of nonsmall-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. Methods: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. Results: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 ( 18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. Conclusions: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalClinical Lung Cancer
Volume13
Issue number2
DOIs
StatePublished - Mar 1 2012

Fingerprint

Non-Small Cell Lung Carcinoma
Meta-Analysis
Neoplasm Metastasis
Fluorodeoxyglucose F18
Mediastinoscopy
Thoracotomy
MEDLINE
Positron Emission Tomography Computed Tomography
Histology
Adenocarcinoma
Odds Ratio
Databases

Keywords

  • Computed tomography
  • FDG-PET
  • Lymph node metastasis
  • Meta-analysis
  • Negative predictive value
  • Nonsmall-cell lung cancer

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 nonsmall-cell lung cancer : A meta-analysis. / Wang, Jingbo; Welch, Kathy; Wang, Luhua; Kong, Feng Ming Spring.

In: Clinical Lung Cancer, Vol. 13, No. 2, 01.03.2012, p. 81-89.

Research output: Contribution to journalArticle

Wang, Jingbo ; Welch, Kathy ; Wang, Luhua ; Kong, Feng Ming Spring. / Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 nonsmall-cell lung cancer : A meta-analysis. In: Clinical Lung Cancer. 2012 ; Vol. 13, No. 2. pp. 81-89.
@article{bdd2d3b2cf1147579a1442beb8e5c7b7,
title = "Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 nonsmall-cell lung cancer: A meta-analysis",
abstract = "Background: Nodal staging of nonsmall-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. Methods: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. Results: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 ( 18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. Conclusions: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.",
keywords = "Computed tomography, FDG-PET, Lymph node metastasis, Meta-analysis, Negative predictive value, Nonsmall-cell lung cancer",
author = "Jingbo Wang and Kathy Welch and Luhua Wang and Kong, {Feng Ming Spring}",
year = "2012",
month = "3",
day = "1",
doi = "10.1016/j.cllc.2011.08.002",
language = "English (US)",
volume = "13",
pages = "81--89",
journal = "Clinical Lung Cancer",
issn = "1525-7304",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 nonsmall-cell lung cancer

T2 - A meta-analysis

AU - Wang, Jingbo

AU - Welch, Kathy

AU - Wang, Luhua

AU - Kong, Feng Ming Spring

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Background: Nodal staging of nonsmall-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. Methods: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. Results: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 ( 18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. Conclusions: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.

AB - Background: Nodal staging of nonsmall-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. Methods: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. Results: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 ( 18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. Conclusions: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.

KW - Computed tomography

KW - FDG-PET

KW - Lymph node metastasis

KW - Meta-analysis

KW - Negative predictive value

KW - Nonsmall-cell lung cancer

UR - http://www.scopus.com/inward/record.url?scp=84863158927&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863158927&partnerID=8YFLogxK

U2 - 10.1016/j.cllc.2011.08.002

DO - 10.1016/j.cllc.2011.08.002

M3 - Article

C2 - 22056226

AN - SCOPUS:84863158927

VL - 13

SP - 81

EP - 89

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

SN - 1525-7304

IS - 2

ER -