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Dynamic contrast–enhanced computed tomography for the diagnosis of solitary pulmonary nodules: a systematic review and meta-analysis

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Abstract

Introduction

A systematic review and meta-analysis were performed to determine the diagnostic performance of dynamic contrast–enhanced computed tomography (DCE-CT) for the differentiation between malignant and benign pulmonary nodules.

Methods

Ovid MEDLINE and EMBASE were searched for studies published up to October 2018 on the diagnostic accuracy of DCE-CT for the characterisation of pulmonary nodules. For the index test, studies with a minimum of a pre- and post-contrast computed tomography scan were evaluated. Studies with a reference standard of biopsy for malignancy, and biopsy or 2-year follow-up for benign disease were included. Study bias was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). The sensitivities, specificities, and diagnostic odds ratios were determined along with 95% confidence intervals (CIs) using a bivariate random effects model.

Results

Twenty-three studies were included, including 2397 study participants with 2514 nodules of which 55.3% were malignant (1389/2514). The pooled accuracy results were sensitivity 94.8% (95% CI 91.5; 96.9), specificity 75.5% (69.4; 80.6), and diagnostic odds ratio 56.6 (24.2–88.9). QUADAS 2 assessment showed intermediate/high risk of bias in a large proportion of the studies (52–78% across the domains). No difference was present in sensitivity or specificity between subgroups when studies were split based on CT technique, sample size, nodule size, or publication date.

Conclusion

DCE-CT has a high diagnostic accuracy for the diagnosis of pulmonary nodules although study quality was indeterminate in a large number of cases.

Key Points

• The pooled accuracy results were sensitivity 95.1% and specificity 73.8% although individual studies showed wide ranges of values.

• This is comparable to the results of previous meta-analyses of PET/CT (positron emission tomography/computed tomography) diagnostic accuracy for the diagnosis of solitary pulmonary nodules.

• Robust direct comparative accuracy and cost-effectiveness studies are warranted to determine the optimal use of DCE-CT and PET/CT in the diagnosis of SPNs.

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Abbreviations

DCE-CT:

Dynamic contrast–enhanced computed tomography

DOR:

Diagnostic odds ratio

HU:

Hounsfield units

NLR:

Negative likelihood ratio

PET:

Positron emission tomography

PLR:

Positive likelihood ratio

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

SPN:

Solitary pulmonary nodules

SROC:

Summary receiver operator characteristic

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Disclaimer

The views expressed are those of the authors and not necessarily those of the NHS, NIHR, or Department of Health.

Funding

The study was funded by NIHR Health Technology Assessment programme, project number 09 22 117 and supported by the NIHR Cambridge Biomedical Research Centre. AC is part-funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). FJG is part-funded by an NIHR Senior Investigator award. RCR is part-funded by Cambridge Biomedical Research Centre and Cambridge Cancer Centre. NRQ is part-funded by Cambridge BRC. The funders had no role in the design, analysis, or write-up of the study.

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Authors and Affiliations

  1. Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK

    Jonathan R. Weir-McCall, Stella Joyce, James W. MacKay, Gabrielle Baxter & Fiona J. Gilbert

  2. School of Health Sciences, Faculty of Health and Wellbeing, University of Central Lancashire, Lancashire, UK

    Andrew Clegg

  3. Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK

    Lena-Marie Dendl

  4. Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge, UK

    Robert C. Rintoul

  5. Department of Oncology, University of Cambridge, Cambridge, UK

    Robert C. Rintoul

  6. Department of Radiology, Royal Papworth Hospital, Cambridge, UK

    Nagmi R. Qureshi

  7. Institute of Nuclear Medicine, University College London, London, UK

    Ken Miles

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  1. Jonathan R. Weir-McCall
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Correspondence to Jonathan R. Weir-McCall.

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The scientific guarantor of this publication is FJG.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was not required for this study because it is a meta-analysis of published anonymous data.

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Institutional Review Board approval was not required because it is a meta-analysis of published anonymous data.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the respective original scientific articles from which the data has been extracted by meta-analysis.

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Weir-McCall, J.R., Joyce, S., Clegg, A. et al. Dynamic contrast–enhanced computed tomography for the diagnosis of solitary pulmonary nodules: a systematic review and meta-analysis. Eur Radiol 30, 3310–3323 (2020). https://doi.org/10.1007/s00330-020-06661-8

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