Gould Michael K, Kuschner Ware G, Rydzak Chara E, Maclean Courtney C, Demas Anita N, Shigemitsu Hidenobu, Chan Jo Kay, Owens Douglas K
Pulmonary Section (111P), Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA.
Ann Intern Med. 2003 Dec 2;139(11):879-92. doi: 10.7326/0003-4819-139-11-200311180-00013.
To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET depend on the presence or absence of enlarged mediastinal lymph nodes on CT).
Computerized search of MEDLINE, EMBASE, BIOSIS, and CancerLit through March 2003 and reference lists of retrieved studies and review articles.
Studies in any language that examined FDG-PET for mediastinal staging in patients with known or suspected non-small-cell lung cancer, enrolled at least 10 participants (including at least 5 participants with mediastinal metastasis), and provided enough data to permit calculation of sensitivity and specificity for identifying lymph node involvement.
One reviewer (of non-English-language studies) or 2 reviewers (of English-language studies) independently evaluated studies for inclusion, rated methodologic quality, and abstracted relevant data.
Thirty-nine studies met inclusion criteria. Methodologic quality varied, but few aspects of study quality affected diagnostic accuracy. The authors constructed summary receiver-operating characteristic curves for CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more accurate than CT for identifying lymph node involvement (P < 0.001). For CT, median sensitivity and specificity were 61% (interquartile range, 50% to 71%) and 79% (interquartile range, 66% to 89%), respectively. For FDG-PET, median sensitivity and specificity were 85% (interquartile range, 67% to 91%) and 90% (interquartile range, 82% to 96%), respectively. Fourteen studies provided information about the conditional test performance of CT and FDG-PET. Positron emission tomography with 18-fluorodeoxyglucose was more sensitive but less specific when CT showed enlarged lymph nodes (median sensitivity, 100% [interquartile range, 90% to 100%]; median specificity, 78% [interquartile range, 68% to 100%]) than when CT showed no lymph node enlargement (median sensitivity, 82% [interquartile range, 65% to 100%]; median specificity, 93% [interquartile range, 92% to 100%]; P = 0.002).
Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.
比较计算机断层扫描（CT）和18-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在非小细胞肺癌患者纵隔分期中的诊断准确性，并确定检查结果是否存在条件依赖性（FDG-PET的敏感性和特异性取决于CT上纵隔淋巴结是否肿大）。
通过检索MEDLINE、EMBASE、BIOSIS和CancerLit至2003年3月，并查阅检索到的研究及综述文章的参考文献列表。
纳入任何语言的研究，这些研究对已知或疑似非小细胞肺癌患者进行FDG-PET纵隔分期检查，纳入至少10名参与者（包括至少5名有纵隔转移的参与者），并提供足够数据以计算识别淋巴结受累的敏感性和特异性。
一名审阅者（针对非英语研究）或两名审阅者（针对英语研究）独立评估研究是否纳入，对方法学质量进行评分，并提取相关数据。
39项研究符合纳入标准。方法学质量各不相同，但研究质量的几个方面对诊断准确性影响不大。作者构建了CT和FDG-PET的汇总受试者工作特征曲线。18-氟脱氧葡萄糖正电子发射断层扫描在识别淋巴结受累方面比CT更准确（P < 0.001）。对于CT，中位敏感性和特异性分别为61%（四分位间距，50%至71%）和79%（四分位间距，66%至89%）。对于FDG-PET，中位敏感性和特异性分别为85%（四分位间距，67%至91%）和90%（四分位间距，82%至96%）。14项研究提供了关于CT和FDG-PET条件性检查性能的信息。当CT显示淋巴结肿大时，18-氟脱氧葡萄糖正电子发射断层扫描更敏感但特异性较低（中位敏感性，100%[四分位间距，90%至100%]；中位特异性，78%[四分位间距，68%至100%]），而当CT显示无淋巴结肿大时（中位敏感性，82%[四分位间距，65%至100%]；中位特异性，93%[四分位间距，92%至100%]；P = 0.002）。
18-氟脱氧葡萄糖正电子发射断层扫描在纵隔分期方面比CT更准确。当CT显示纵隔淋巴结肿大时，18-氟脱氧葡萄糖正电子发射断层扫描更敏感但特异性较低。
