Accuracy of FDG-PET for differentiating benign from malignant pleural effusions : A meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en juin 2013 (14 études, 639 patients), cette méta-analyse évalue la sensibilité et la spécificité de différentes techniques de tomographie par émission de positrons à base de fluorodésoxyglucose (18F) pour différencier un épanchement pleural malin d'un épanchement pleural bénin
Background : The role of FDG-PET imaging for diagnosing malignant pleural effusions is not well defined. The aim of this study was to summarize the evidence for its use in ruling in or out the malignant origin of a pleural effusion and/or thickening.
Methods : Meta-analysis of diagnostic accuracy studies published in the Cochrane library, PubMed and Embase (inception to June 2013) without language restrictions. Two investigators selected studies that had evaluated the performance of FDG-PET in patients with pleural effusions and/or thickening, using pleural cyto- or histopathology as the reference standard for malignancy. Subgroup analyses were conducted according to FDG-PET imaging interpretation (qualitative or semi-quantitative), PET equipment (PET vs integrated PET-CT) and/or target population (known lung cancer or malignant pleural mesothelioma). Study quality was assessed using QUADAS-2. We used a bivariate random-effects model for the analysis and pooling of diagnostic performance measures across studies.
Results : Fourteen non-high risk of bias studies, comprising 407 patients with malignant and 232 with benign pleural conditions met the inclusion criteria. Semi-quantitative PET readings had a significantly lower sensitivity for diagnosing malignant effusions than visual assessments (82% vs 91%, p=0.026). The pooled test characteristics of integrated PET-CT systems using semi-quantitative interpretations for identifying malignant effusions were: sensitivity 81%, specificity 74%, positive LR 3.22, negative LR 0.26, and AUC 0.838. Resultant data were heterogeneous, and spectrum bias should be considered when appraising FDG-PET operating characteristics.
Conclusions : The moderate accuracy of PET-CT using semi-quantitative readings precludes its routine recommendation for discriminating malignant from benign pleural effusions.
Systematic Review Registration Number International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42011001392. http://www.crd.york.ac.uk/prospero/
Chest , résumé, 2013