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Solitary pulmonary nodules and masses: a meta-analysis of the diagnostic utility of alternative imaging tests

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Abstract

The purpose was to assess the clinical utility of diagnostic tests for identifying malignancy within a solitary pulmonary nodule (SPN), and to create a nomogram or “look-up” table using clinical data and non-invasive radiology (positive) test results to estimate post-test probability of malignancy. Studies that examined computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) for the evaluation of SPN. Two reviewers independently abstracted data and assessed study quality. Study-specific and overall positive likelihood ratios (LRs) for each diagnostic test confirming a diagnosis of malignancy and negative LR for each diagnostic test excluding a diagnosis of malignancy within an SPN were calculated. Forty-four of 242 articles were included. Positive LRs for diagnostic tests were: CT 3.91 (95% confidence interval 2.42, 5.40), MRI 4.57 (3.03, 6.1), PET 5.44 (3.56, 7.32) and SPECT 5.16 (4.03, 6.30). Negative LRs were: CT 0.10 (0.03, 0.16), MRI 0.08 (0.03, 0.12), PET 0.06 (0.02, 0.09) and SPECT 0.06 (0.04, 0.08). Differences in performance for all tests were negligible; therefore, the clinician may confidently use any of the four tests presented in further evaluating an SPN. Given the low cost and prevalence of the technology, SPECT appears to be the leading choice for additional testing in SPN evaluation.

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Acknowledgments

This work was funded in part by NIH/NCI 1 K07 CA108664 01A1 and GE-AUR Radiology Research Academic Fellowship.

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Authors and Affiliations

  1. Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Medical Center, B1 132F Taubman Center/0302, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0030, USA

    Paul Cronin & Aine Marie Kelly

  2. Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA

    Ben A. Dwamena

  3. Department of Radiology, Division of Magnetic Resonance Imaging, University of Michigan Medical Center, Ann Arbor, MI, USA

    Ruth C. Carlos

  4. Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA

    Steven J. Bernstein

  5. VA HSR&D Center of Excellence, Ann Arbor, MI, USA

    Steven J. Bernstein

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  1. Paul Cronin
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  2. Ben A. Dwamena
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  3. Aine Marie Kelly
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  4. Steven J. Bernstein
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  5. Ruth C. Carlos
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Corresponding author

Correspondence to Paul Cronin.

Appendix

Appendix

Nomogram of post-test probability of malignancy in an SPN. For categorical predictors (cigarettes, other cancer, spiculation, and upper lobe), 0 indicates absent, 1 indicates present (35 years, 55 years, and 75 years refer to the age of the patients; 10 mm, 20 mm, and 30 mm refer to the size of the SPN)

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Cronin, P., Dwamena, B.A., Kelly, A.M. et al. Solitary pulmonary nodules and masses: a meta-analysis of the diagnostic utility of alternative imaging tests. Eur Radiol 18, 1840–1856 (2008). https://doi.org/10.1007/s00330-008-0970-5

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