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Lung cancer diagnostic test loses specificity in areas with endemic lung infections
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PET imaging with fludeoxyglucose F 18 less reliably diagnosed malignant lung lesions in populations with endemic infectious lung disease, according to results of a pooled analysis.
Stephen A. Deppen, PhD, of the department of thoracic surgery at Vanderbilt University Medical Center, and colleagues evaluated data from 70 studies that assessed the sensitivity and specificity of fludeoxyglucose F 18 (FDG) and PET to diagnosis lung cancer. The studies included 8,511 suspicious lung nodules, 60% of which (n=5,105) were malignant.
Stephen A. Deppen
Results of the pooled analysis demonstrated significant heterogeneity in sensitivity (
Researchers calculated an 89% rate for sensitivity (95% CI, 86-91) and a 75% rate for specificity (95% CI, 71-79) of FDG-PET to detect lung cancer.
Ten of the studies in the analysis were conducted in areas where infectious lung disease was endemic to the local population. These studies included 1,431 individuals, including 1,082 with cancer (76%).
Researchers found the average adjusted estimate of FDG-PET specificity was lower in regions with endemic lung disease (61%; 95% CI, 49-72) than in nonendemic regions (77%; 95% CI, 73-80).
The lower specificity persisted in regions with endemic disease when researchers only included rigorously conducted and well-controlled studies in their analysis (66% vs. 80%).
However, the average adjusted sensitivity was similar in endemic (94%; 95% CI, 90-96) and nonendemic (88%; 95% CI, 85-90) regions.
“FDG-PET for the diagnosis of lung cancer in patients who reside in a region with significant endemic infectious lung disease should be recognized as having lower specificity (approximately 61%) than previously reported,” Deppen and colleagues wrote. “Knowledge of this reduction in specificity should limit the use of FDG-PET to diagnose lung cancer unless substantial institutional expertise in FDG-PET interpretation has been proven. Should low-dose CT screening for lung cancer become the diagnostic standard, knowledge of FDG-PET/CT performance is even more critical because the vast majority of indeterminate lung nodules detected through screening are benign.”
Disclosure: The researchers report no relevant financial disclosures.
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