Solitary Pulmonary Nodules: Meta-analytic Comparison of Cross-sectional Imaging Modalities for Diagnosis of Malignancy

Purpose: To perform a meta-analysis to estimate the diagnostic accuracy of dynamic contrast material–enhanced computed tomography (CT) and magnetic resonance (MR) imaging, fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and technetium 99m (99mTc) depreotide single photon emission computed tomography (SPECT) for evaluation of solitary pulmonary nodules (SPNs).

Materials and Methods: Data sources were studies published in PubMed between January 1990 and December 2005. The selected investigations were comparative and noncomparative diagnostic cohort studies to examine the operating characteristics of the four imaging modalities for evaluation of SPNs, involving at least 10 enrolled participants with histologic confirmation and having sufficient data to calculate contingency tables. A random coefficient binary regression model with disease probability conditioned on test results was used to summarize test performance and construct summary receiver operating characteristic (ROC) curves. Sensitivities, specificities, predictive values, diagnostic odds ratios, and areas under the ROC curve were calculated.

Results: Forty-four studies—10 dynamic CT, six dynamic MR, 22 FDG PET, and seven 99mTc-depreotide SPECT—met the inclusion criteria. (One study was included in both the FDG PET and SPECT groups.) Sensitivities, specificities, positive predictive values, negative predictive values, diagnostic odds ratios, and areas under the ROC curve were, respectively, 0.93 (95% confidence interval [CI]: 0.88, 0.97), 0.76 (95% CI: 0.68, 0.97), 0.80 (95% CI: 0.74, 0.86), 0.95 (95% CI: 0.93, 0.98), 39.91 (95% CI: 1.21, 81.04), and 0.93 (95% CI: 0.81, 0.97) for dynamic CT; 0.94 (95% CI: 0.91, 0.97), 0.79 (95% CI: 0.73, 0.86), 0.86 (95% CI: 0.83, 0.89), 0.93 (95% CI: 0.90, 0.96), 60.59 (95% CI: 5.56, 115.62), and 0.94 (95% CI: 0.83, 0.98) for dynamic MR; 0.95 (95% CI: 0.93, 0.98), 0.82 (95% CI: 0.77, 0.88), 0.91 (95% CI: 0.88, 0.93), 0.90 (95% CI: 0.85, 0.94), 97.31 (95% CI: 6.26, 188.37), and 0.94 (95% CI: 0.83, 0.98) for FDG PET; and 0.95 (95% CI: 0.93, 0.97), 0.82 (95% CI: 0.78, 0.85), 0.90 (95% CI: 0.83, 0.97), 0.91 (95% CI: 0.84, 0.98), 84.50 (95% CI: 34.28, 134.73), and 0.94 (95% CI: 0.83, 0.98) for 99mTc-depreotide SPECT.

Conclusion: Dynamic CT and MR, FDG PET, and 99mTc-depreotide SPECT are noninvasive and accurate in distinguishing malignant from benign SPNs; differences among these tests are nonsignificant.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2463062148/DC1

© RSNA, 2008

References

  • 1 Cronin P. Thoracic CT. Appl Radiol 2003; 32: 14–27.
  • 2 Winer-Muram H. The solitary pulmonary nodule. Radiology 2006;239(1):34–49.
  • 3 Nolop KB, Rhodes CG, Brudin LH, et al. Glucose utilization in vivo by human pulmonary neoplasms. Cancer 1987;60(11):2682–2689.
  • 4 Worsley DF, Celler A, Adam MJ, et al. Pulmonary nodules: differential diagnosis using 18F-fluorodeoxyglucose single-photon emission computed tomography. AJR Am J Roentgenol 1997;168(3):771–774.
  • 5 Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285(7):914–924.
  • 6 Blum JE, Handmaker H, Rinne NA. The utility of a somatostatin-type receptor binding peptide radiopharmaceutical (P829) in the evaluation of solitary pulmonary nodules. Chest 1999;115(1):224–232.
  • 7 Awaya H, Matsumoto T, Honjo K, Miura G, Emoto T, Matsunaga N. A preliminary study of discrimination among the components of small pulmonary nodules by MR imaging: correlation between MR images and histologic appearance. Radiat Med 2000;18(1):29–38.
  • 8 Khan KS. Systematic reviews of diagnostic tests: a guide to methods and application. Best Pract Res Clin Obstet Gynaecol 2005;19(1):37–46.
  • 9 Deville WL, Buntinx F, Bouter LM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2002;2:9.
  • 10 Bachmann LM, Bischof DB, Bischofberger SA, Bonani MG, Osann FM, Steurer J. Systematic quantitative overviews of the literature to determine the value of diagnostic tests for predicting acute appendicitis: study protocol. BMC Surg 2002;2:2.
  • 11 Honest H, Khan KS. Reporting of measures of accuracy in systematic reviews of diagnostic literature. BMC Health Serv Res 2002;2(1):4.
  • 12 Coughlin SS, Trock B, Criqui H, Pickle LW, Browner D, Tefft MC. The logistic modeling of sensitivity, specificity and predictive value of a diagnostic test. J Clin Epidemiol 1992;45(1):1–7.
  • 13 Knottnerus JA. Application of logistic regression to the analysis of diagnostic data: exact modeling of a probability tree of multiple binary variables. Med Decis Making 1992;12(2):93–108.
  • 14 Greiner M, Gardner IA. Epidemiologic issues in the validation of veterinary diagnostic tests. Prev Vet Med 2000;45(1-2):3–22.
  • 15 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560.
  • 16 Wang MC, Bushman BJ. Using normal quantile plots to explore meta-analysis data sets. Psychol Methods 1998;3:46–54.
  • 17 Swensen SJ, Morin RL, Schueler BA, et al. Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material—a preliminary report. Radiology 1992;182(2):343–347.
  • 18 Swensen SJ, Brown LR, Colby TV, Weaver AL. Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology 1995;194(2):393–398.
  • 19 Yamashita K, Matsunobe S, Tsuda T, et al. Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT. Radiology 1995;194(2):399–405.
  • 20 Swensen SJ, Brown LR, Colby TV, Weaver AL, Midthun DE. Lung nodule enhancement at CT: prospective findings. Radiology 1996;201(2):447–455.
  • 21 Potente G, Iacari V, Caimi M. The challenge of solitary pulmonary nodules: HRCT evaluation. Comput Med Imaging Graph 1997;21(1):39–46.
  • 22 Zhang M, Kono M. Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology 1997;205(2):471–478.
  • 23 Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000;214(1):73–80.
  • 24 Yi CA, Lee KS, Kim EA, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology 2004;233(1):191–199.
  • 25 Kim JH, Kim HJ, Lee KH, Kim KH, Lee HL. Solitary pulmonary nodules: a comparative study evaluated with contrast-enhanced dynamic MR imaging and CT. J Comput Assist Tomogr 2004;28(6):766–775.
  • 26 Jeong YJ, Lee KS, Jeong SY, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi–detector row CT. Radiology 2005;237(2):675–683.
  • 27 Hittmair K, Eckersberger F, Klepetko W, Helbich T, Herold CJ. Evaluation of solitary pulmonary nodules with dynamic contrast-enhanced MR imaging: a promising technique. Magn Reson Imaging 1995;13(7):923–933.
  • 28 Guckel C, Schnabel K, Deimling M, Steinbrich W. Solitary pulmonary nodules: MR evaluation of enhancement patterns with contrast-enhanced dynamic snapshot gradient-echo imaging. Radiology 1996;200(3):681–686.
  • 29 Ohno Y, Hatabu H, Takenaka D, Adachi S, Kono M, Sugimura K. Solitary pulmonary nodules: potential role of dynamic MR imaging in management—initial experience. Radiology 2002;224(2):503–511.
  • 30 Schaefer JF, Vollmar J, Schick F, et al. Solitary pulmonary nodules: dynamic contrast-enhanced MR imaging—perfusion differences in malignant and benign lesions. Radiology 2004;232(2):544–553.
  • 31 Tozaki M, Ichiba N, Fukuda K. Dynamic magnetic resonance imaging of solitary pulmonary nodules: utility of kinetic patterns in differential diagnosis. J Comput Assist Tomogr 2005;29(1):13–19.
  • 32 Kubota K, Matsuzawa T, Fujiwara T, et al. Differential diagnosis of lung tumor with positron emission tomography: a prospective study. J Nucl Med 1990;31(12):1927–1932.
  • 33 Gupta NC, Frank AR, Dewan NA, et al. Solitary pulmonary nodules: detection of malignancy with PET with 2-[F18]-fluoro-2-deoxy-D-glucose. Radiology 1992;184(2):441–444.
  • 34 Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP. Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules: potential role in evaluation and management. Chest 1993;104(4):997–1002.
  • 35 Patz EF Jr, Lowe VJ, Hoffman JM, et al. Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 1993;188(2):487–490.
  • 36 Dewan NA, Reeb SD, Gupta NC, Gobar LS, Scott WJ. PET-FDG imaging and transthoracic needle lung aspiration biopsy in evaluation of pulmonary lesions: a comparative risk-benefit analysis. Chest 1995;108(2):441–446.
  • 37 Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. Detection of primary and recurrent lung cancer by means of F-18 fluorodeoxyglucose positron emission tomography (FDG PET). J Thorac Cardiovasc Surg 1995;110(1):130–139.
  • 38 Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. Lung tumor growth correlates with glucose metabolism measured by fluoride-18 fluorodeoxyglucose positron emission tomography. Ann Thorac Surg 1995;60(5):1348–1352.
  • 39 Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 1996;37(6):943–948.
  • 40 Bury T, Dowlati A, Paulus P, et al. Evaluation of the solitary pulmonary nodule by positron emission tomography imaging. Eur Respir J 1996;9(3):410–414.
  • 41 Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K. Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan. Chest 1997;112(2):416–422.
  • 42 Hagberg RC, Segall GM, Stark P, Burdon TA, Pompili MF. Characterization of pulmonary nodules and mediastinal staging of bronchogenic carcinoma with F-18 fluorodeoxyglucose positron emission tomography. Eur J Cardiothorac Surg 1997;12(1):92–97.
  • 43 Gupta N, Gill H, Graeber G, Bishop H, Hurst J, Stephens T. Dynamic positron emission tomography with F-18 fluorodeoxyglucose imaging in differentiation of benign from malignant lung/mediastinal lesions. Chest 1998;114(4):1105–1111.
  • 44 Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998;16(3):1075–1084.
  • 45 Orino K, Kawamura M, Hatazawa J, Suzuki I, Sazawa Y. Efficacy of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans in diagnosis of pulmonary nodules [in Japanese]. Jpn J Thorac Cardiovasc Surg 1998;46(12):1267–1274.
  • 46 Prauer HW, Weber WA, Romer W, Treumann T, Ziegler SI, Schwaiger M. Controlled prospective study of positron emission tomography using the glucose analogue [18f] fluorodeoxyglucose in the evaluation of pulmonary nodules. Br J Surg 1998;85(11):1506–1511.
  • 47 Lee J, Aronchick JM, Alavi A. Accuracy of F-18 fluorodeoxyglucose positron emission tomography for the evaluation of malignancy in patients presenting with new lung abnormalities: a retrospective review. Chest 2001;120(6):1791–1797.
  • 48 Higashi K, Ueda Y, Sakuma T, et al. Comparison of [(18)F]FDG PET and (201)TI SPECT in evaluation of pulmonary nodules. J Nucl Med 2001;42(10):1489–1496.
  • 49 Hung GU, Shiau YC, Tsai SC, Ho YJ, Kao CH, Yen RF. Differentiation of radiographically indeterminate solitary pulmonary nodules with. Jpn J Clin Oncol 2001;31(2):51–54.
  • 50 Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Visual and semiquantitative analyses for F-18 fluorodeoxyglucose PET scanning in pulmonary nodules 1 cm to 3 cm in size. Ann Thorac Surg 2005;79(3):984–988.
  • 51 Herder GJ, Golding RP, Hoekstra OS, et al. The performance of (18)F-fluorodeoxyglucose positron emission tomography in small solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 2004;31(9):1231–1236.
  • 52 Lin WY, Chang GC, Wang SJ. Effectiveness of FDG-PET scans in the evaluation of patients with single pulmonary nodules in Taiwan. Ann Nucl Med Sci 2004;17:63–68.
  • 53 Halley A, Hugentobler A, Icard P, et al. Efficiency of 18F-FDG and 99mTc-depreotide SPECT in the diagnosis of malignancy of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 2005;32(9):1026–1032.
  • 54 Blum J, Handmaker H, Lister-James J, Rinne N. A multicenter trial with a somatostatin analog (99m) Tc depreotide in the evaluation of solitary pulmonary nodules. Chest 2000;117(5):1232–1238.
  • 55 Grewal RK, Dadparvar S, Yu JQ, et al. Efficacy of Tc-99m depreotide scintigraphy in the evaluation of solitary pulmonary nodules. Cancer J 2002;8(5):400–404.
  • 56 Baath M, Kolbeck KG, Danielsson R. Somatostatin receptor scintigraphy with 99mTc-depreotide (NeoSpect) in discriminating between malignant and benign lesions in the diagnosis of lung cancer: a pilot study. Acta Radiol 2004;45(8):833–839.
  • 57 Kahn D, Menda Y, Kernstine K, et al. The utility of 99mTc depreotide compared with F-18 fluorodeoxyglucose positron emission tomography and surgical staging in patients with suspected non-small cell lung cancer. Chest 2004;125(2):494–501.
  • 58 Martins T, Lino JS, Ramos S, Oliveira L. 99mTc-depreotide scintigraphy in the evaluation of indeterminate pulmonary lesions: clinical experience. Cancer Biother Radiopharm 2004;19(2):253–259.
  • 59 Bourguet P; for Groupe de Travail SOR. 2002 standards, options and recommendations for the use of [18F]-FDG (PET-FDG) in cancerology [in French]. Bull Cancer 2003;90(Spec Issue):S1–S109.
  • 60 Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract 2003;93(1):C29–C34.
  • 61 McAuley L, Pham B, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 2000;356(9237):1228–1231.

Article History

Published in print: 2008