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Diagnostic potential of [18F]FDG PET/MRI in non-small cell lung cancer lymph node metastasis: a meta-analysis

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Abstract

Purpose

This meta-analysis evaluated the diagnostic accuracy and diagnostic value of [18F]FDG PET/MRI for mediastinal lymph node staging of NSCLC.

Methods

Relevant articles in PubMed, Embase, Web of Science, and the Cochrane Library were searched until January 2023. Research evaluating [18F]FDG PET/MRI for mediastinal lymph node staging of NSCLC was included. Pooled estimates of sensitivity, specificity, PLR, and NLR were calculated by the "Stata" software.

Results

Nine researches were included, containing 618 patients. The pooled sensitivity of [18F]FDG PET/MRI for detecting mediastinal lymph node staging of NSCLC was 0.82 (0.70–0.90), and the pooled specificity was 0.88 (0.82–0.93). PLR and NLR were 7.38 (4.73–11.52) and 0.20 (0.11–0.36), respectively. The AUC value of this imaging modality was 0.92 (0.90–0.94). The post-test probability for [18F]FDG PET/MRI might rise to 88% when the pre-test probability was set at 50%.

Conclusions

We considered [18F]FDG PET/MRI as an effective imaging tool with relatively high specificity and sensitivity. It has great potential to be used in the clinical management of patients in NSCLC who are amenable to early surgery. More studies with large sample sizes in the same direction are needed in future to obtain more reliable evidence-based support.

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Data availability statement

The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.

References

  1. Bray F, Laversanne M, Weiderpass E, et al. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. 2021;127:3029–30.

    Article  PubMed  Google Scholar 

  2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.

    Article  PubMed  Google Scholar 

  3. Sher T, Dy GK, Adjei AA. Small cell lung cancer. Mayo Clin Proc. 2008;83:355–67.

    Article  PubMed  CAS  Google Scholar 

  4. Travis WD, Brambilla E, Riely GJ. New pathologic classification of lung cancer: relevance for clinical practice and clinical trials. J Clin Oncol. 2013;31:992–1001.

    Article  PubMed  CAS  Google Scholar 

  5. Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med. 2000;343:254–61.

    Article  PubMed  CAS  Google Scholar 

  6. De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014;45:787–98.

    Article  PubMed  Google Scholar 

  7. Weder W, Schmid RA, Bruchhaus H, et al. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg. 1998;66:886–92.

    Article  PubMed  CAS  Google Scholar 

  8. Valk PE, Pounds TR, Hopkins DM, et al. Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. Ann Thorac Surg. 1995;60:1573–81.

    Article  PubMed  CAS  Google Scholar 

  9. Arita T, Kuramitsu T, Kawamura M, et al. Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes. Thorax. 1995;50:1267–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Rankin S. PET/CT for staging and monitoring non small cell lung cancer. Cancer Imaging. 2008. https://doi.org/10.1102/1470-7330.2008.9006.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang Q, Zhang X, Wei W, et al. PET imaging of lung cancers in precision medicine: current landscape and future perspective. Mol Pharm. 2022;19:3471–83.

    Article  PubMed  CAS  Google Scholar 

  12. Manafi-Farid R, Askari E, Shiri I, et al. [(18)F]FDG-PET/CT radiomics and artificial intelligence in lung cancer: technical aspects and potential clinical applications. Semin Nucl Med. 2022;52:759–80.

    Article  PubMed  Google Scholar 

  13. Kaseda K. Recent and current advances in FDG-pet imaging within the field of clinical oncology in NSCLC: a review of the literature. Diagnostics (Basel). 2020;10(8):561.

    Article  PubMed  CAS  Google Scholar 

  14. Wu LM, Xu JR, Gu HY, et al. Preoperative mediastinal and hilar nodal staging with diffusion-weighted magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography in patients with non-small-cell lung cancer: which is better? J Surg Res. 2012;178:304–14.

    Article  PubMed  Google Scholar 

  15. Matoba M, Tonami H, Kondou T, et al. Lung carcinoma: diffusion-weighted mr imaging–preliminary evaluation with apparent diffusion coefficient. Radiology. 2007;243:570–7.

    Article  PubMed  Google Scholar 

  16. Al-Ibraheem A, Hirmas N, Fanti S, et al. Impact of (18)F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC. BMC Med Imaging. 2021;21:49.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kajiyama A, Ito K, Watanabe H, et al. Consistency and prognostic value of preoperative staging and postoperative pathological staging using (18)F-FDG PET/MRI in patients with non-small cell lung cancer. Ann Nucl Med. 2022;36:1059–72.

    Article  PubMed  CAS  Google Scholar 

  18. Sun J, Li Y, Gong F, et al. The diagnostic value of PET/CT for the lymph node metastasis in Asian patients with non-small cell lung cancer: A meta-analysis. Hell J Nucl Med. 2022;25:196–204.

    PubMed  Google Scholar 

  19. Zhao L, He ZY, Zhong XN, et al. (18)FDG-PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer: a meta-analysis. Surg Oncol. 2012;21:230–6.

    Article  PubMed  Google Scholar 

  20. Schmidt-Hansen M, Baldwin DR, Hasler E, et al. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev. 2014;2014:Cd009519.

    PubMed  PubMed Central  Google Scholar 

  21. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.

    Article  PubMed  Google Scholar 

  22. Berlin JA. Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet. 1997;350:185–6.

    Article  PubMed  CAS  Google Scholar 

  23. Zamora J, Abraira V, Muriel A, et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Heusch P, Buchbender C, Köhler J, et al. Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014;55:373–8.

    Article  PubMed  CAS  Google Scholar 

  25. Fraioli F, Screaton NJ, Janes SM, et al. Non-small-cell lung cancer resectability: diagnostic value of PET/MR. Eur J Nucl Med Mol Imaging. 2015;42:49–55.

    Article  PubMed  CAS  Google Scholar 

  26. Ohno Y, Koyama H, Yoshikawa T, et al. Three-way comparison of whole-body MR, coregistered whole-body FDG PET/MR, and integrated whole-body FDG PET/CT imaging: TNM and stage assessment capability for non-small cell lung cancer patients. Radiology. 2015;275:849–61.

    Article  PubMed  Google Scholar 

  27. Huellner MW, Galiza Barbosa FD, Husmann L, et al. TNM staging of non-small cell lung cancer: comparison of PET/MR and PET/CT. J Nucl Med. 2016;57:21–6.

    Article  PubMed  CAS  Google Scholar 

  28. Lee SM, Goo JM, Park CM, et al. Preoperative staging of non-small cell lung cancer: prospective comparison of PET/MR and PET/CT. Eur Radiol. 2016;26:3850–7.

    Article  PubMed  Google Scholar 

  29. Kirchner J, Sawicki LM, Schaarschmidt BM, et al. Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2018;45:S502.

    Google Scholar 

  30. Ohno Y, Takeshi Y, Takenaka D, et al. Comparison of diagnostic accuracy for TNM stage among whole-body MRI and coregistered PET/MRI using 1.5-T and 3-T MRI systems and integrated PET/CT for non-small cell lung cancer. Am J Roentgenol. 2020;215:1191–8.

    Article  Google Scholar 

  31. Kajiyama A, Ito K, Watanabe H, et al. Consistency and prognostic value of preoperative staging and postoperative pathological staging using(18)F-FDG PET/MRI in patients with non-small cell lung cancer. Ann Nucl Med. 2022;36(12):1059–72.

    Article  PubMed  CAS  Google Scholar 

  32. Wang M-L, Zhang H, Yu H-J, et al. An initial study on the comparison of diagnostic performance of 18F-FDG PET/MR and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer: Focus on pleural invasion. Rev Esp Med Nucl Imagen Mol. 2022;42:16–23.

    PubMed  Google Scholar 

  33. Nasim F, Sabath BF, Eapen GA. Lung cancer. Med Clin North Am. 2019;103:463–73.

    Article  PubMed  Google Scholar 

  34. Pearson FG, DeLarue NC, Ilves R, et al. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982;83:1–11.

    Article  PubMed  CAS  Google Scholar 

  35. Goldstraw P. The role of mediastinoscopic biopsy in preoperative assessment of lung cancer. J Thorac Cardiovasc Surg. 1994;107:309–11.

    Article  PubMed  CAS  Google Scholar 

  36. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e211S – e250.

    Article  PubMed  Google Scholar 

  37. Kostakoglu L, Agress H Jr, Goldsmith SJ. Clinical role of FDG PET in evaluation of cancer patients. Radiographics. 2003;23:315–40. https://doi.org/10.1148/rg.232025705.

    Article  PubMed  Google Scholar 

  38. Pichler BJ, Judenhofer MS, Wehrl HF. PET/MRI hybrid imaging: devices and initial results. Eur Radiol. 2008;18:1077–86.

    Article  PubMed  Google Scholar 

  39. Judenhofer MS, Wehrl HF, Newport DF, et al. Simultaneous PET-MRI: a new approach for functional and morphological imaging. Nat Med. 2008;14:459–65.

    Article  PubMed  CAS  Google Scholar 

  40. Dahlsgaard-Wallenius SE, Hildebrandt MG, Johansen A, et al. Hybrid PET/MRI in non-small cell lung cancer (NSCLC) and lung nodules-a literature review. Eur J Nucl Med Mol Imaging. 2021;48:584–91.

    Article  PubMed  Google Scholar 

  41. Weber W. Clinical PET/MR. Rec Results Cancer Res. 2020;216:747–64.

    Article  CAS  Google Scholar 

  42. Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med. 2001;20:2865–84.

    Article  PubMed  CAS  Google Scholar 

  43. Shen G, Lan Y, Zhang K, et al. Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis. PLoS ONE. 2017;12: e0173104.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wahl RL, Jacene H, Kasamon Y, et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122s-s150.

    Article  PubMed  CAS  Google Scholar 

  45. Miles K, McQueen L, Ngai S, et al. Evidence-based medicine and clinical fluorodeoxyglucose PET/MRI in oncology. Cancer Imaging. 2015;15:18.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Drzezga A, Souvatzoglou M, Eiber M, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study is supported by Education Science and Technology Innovation Project of Gansu Province (2022B-014) and First Hospital of Lanzhou University Intramural Fund (ldyyyn2021-66).

Author information

Authors and Affiliations

  1. The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, Gansu Province, China

    Min Zhang, Wenwen Yang, Yuhang Yuan, Zhikang Liu & Xiaolei Yue

  2. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu Province, China

    Min Zhang, Wenwen Yang, Yuhang Yuan, Zhikang Liu, Xiong Cao & Biao Han

  3. Gansu Province International Cooperation Base for Research and Application of Key Technology of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu Province, China

    Xiong Cao & Biao Han

Authors
  1. Min Zhang
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  4. Zhikang Liu
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  7. Biao Han
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Contributions

MZ conceived and designed the study, which were proofed by BH, MZ, WY and YY collected and analyzed the data. MZ wrote the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Biao Han.

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Zhang, M., Yang, W., Yuan, Y. et al. Diagnostic potential of [18F]FDG PET/MRI in non-small cell lung cancer lymph node metastasis: a meta-analysis. Jpn J Radiol 42, 87–95 (2024). https://doi.org/10.1007/s11604-023-01477-0

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  • DOI: https://doi.org/10.1007/s11604-023-01477-0

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