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The value of four imaging modalities to distinguish malignant from benign solitary pulmonary nodules: a study based on 73 cohorts incorporating 7956 individuals

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Abstract

Background

Solitary pulmonary nodules (SPNs) frequently bother oncologists. The differentiation of malignant from benign nodules with non-invasive approach remains a tough challenge. This study was designed to assess the diagnostic accuracy of dynamic computed tomography (CT), dynamic magnetic resonance imaging (MRI), fluorine 18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), and technetium 99 m (99mTc) depreotide single photon emission computed tomography (SPECT) for SPNs.

Methods

Electronic databases of MEDLINE, PubMed, EMBASE, and Cochrane Library were searched to identify relevant trials. The primary evaluation index of diagnostic accuracy was areas under the summary receiver-operating characteristic (SROC) curve. The results were analyzed utilizing Stata 12.0 statistical software.

Results

Seventy-three trials incorporating 7956 individuals were recruited. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic score, diagnostic odds ratios, and areas under the SROC curve with 95% confidence intervals were, respectively, 0.92 (0.89–0.95), 0.64 (0.54–0.74), 2.60 (1.98–3.42), 0.12 (0.08–0.17), 3.10 (2.62–3.59), 22.24 (13.67–36.17), and 0.91 (0.88–0.93) for CT; 0.92 (0.86–0.95), 0.85 (0.77–0.90), 6.01 (3.90–9.24), 0.10 (0.06–0.17), 4.12 (3.41–4.82), 61.39 (30.41–123.93), and 0.94 (0.92–0.96) for MRI; 0.90 (0.86–0.93), 0.73 (0.65–0.79), 3.28 (2.56–4.20), 0.14 (0.10–0.19), 3.16 (2.69–3.64), 23.68 (14.74–38.05), and 0.90 (0.87–0.92) for 18F-FDG PET; and 0.93 (0.88–0.96), 0.70 (0.56–0.81), 3.12 (2.03–4.81), 0.10 (0.06–0.17), 3.43 (2.63–4.22), 30.74 (13.84–68.27), and 0.93 (0.91–0.95) for 99mTc-depreotide SPECT.

Conclusion

The dynamic MRI, dynamic CT, 18F-FDG PET, and 99mTc-depreotide SPECT were favorable non-invasive approaches to distinguish malignant SPNs from benign. Moreover, from the viewpoint of cost-effectiveness and avoiding radiation, the dynamic MRI was recommendable for SPNs.

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Authors and Affiliations

  1. Department of Oncology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road No 20, Fuzhou, 350005, Fujian, China

    Q. Wu, L. Zhong & X. Xie

  2. Department of Medical Oncology, The Second Hospital of Longyan, Fujian, 364000, China

    L. Zhong

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Wu, Q., Zhong, L. & Xie, X. The value of four imaging modalities to distinguish malignant from benign solitary pulmonary nodules: a study based on 73 cohorts incorporating 7956 individuals. Clin Transl Oncol 23, 296–310 (2021). https://doi.org/10.1007/s12094-020-02418-3

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