Precisión diagnóstica de la FDG-PET para diferenciar derrames pleurales malignos de benignos: revisión sistemática y meta-análisis
Hernández Ferrer, Paula Judit
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Background: The aim of this study was to summarize the evidence for the use of the FDG-PET in ruling in or out the malignant origin of a pleural effusion PE. Methods: A meta analysis was conducted of diagnostic accuracy studies published in the database from inception to June 2013, without language restrictions. Two investigators selected studies that had evaluated the performance of FDG-PET imaging in patients with PE, using pleural histopathology as the reference standard for malignancy. Subgroup analyses were conducted according to FDG-PET imaging interpretation, PET imaging equipment, and/or target population (lung cancer or mesothelioma). Study quality was assessed using QUADAS-2. We used a bivariate random effects model for the analysis and pooling of diagnostic performance measures across studies. Results:Fomieen non-high risk of bias studies, comprising 407 patients with malignant and 232 with benign pleural conditions, met the inclusion criteria. Semiquantitative PET imaging readings had a significantly lower sensitivity for diagnosing malignant PE than visual assessments (82% vs 91%; P=O.026). The pooled test characteristics of integrated PET-CT imaging systems using semiquantitative interpretations for identifying malignant effusions were: sensitivity, 81%; specificity, 74%; positive likelihood ratio (LR), 3.22; negative LR, 0.26; and AUC, 0.838. Resultant data were heterogeneous, and spectrum bias should be considered when appraising FDG-PET imaging operating characteristics.Conclusions:The moderate accuracy of PET-CT imaging using semiquantitative readings precludes its routine recommendation for discriminating malignant from benign PE.
European research projects
- Tesis Doctorals