Diagnostic Accuracy of F18-fluorodeoxyglucose Positron Emission Tomography- computed Tomography for the Detection of Non-small Cell Lung Cancer Recurrence: A Systematic Review and Meta-analysis

Background: The non-small cell variant of lung cancer (NSCLC) has a poorer prognosis. It is typically diagnosed through non-invasive imaging. Of particular note has been FDG-PET/CT, which has been investigated across various settings with differing results. Objective: This study to pool the available information on the diagnostic performance of 18-F FDG PET/CT for detecting NSCLC recurrence. Methods: A systematic literature search was conducted across electronic databases for studies published prior to May 2021. The QUADAS tool was applied to assess study quality, and ta meta-analysis was performed to retrieve pooled estimates. Chi squared tests and I2 statistics were used to assess heterogeneity. Egger’s test and funnel plots were used to assess publication bias. Results: Literature search yielded 20 studies featuring data on 1,973 patients. The majority of the studies had low bias risk. The pooled sensitivity and specificity were 96% (95% CI: 91%-98%) and 93% (95% CI: 89%-95%), respectively. The LRP and LRN estimates were in the left upper quadrant of the LR scattergram, indicating that F18-FDG PET/CT can be utilized for both confirmation and exclusion. The AUC was 0.98 (95% CI: 0.92-0.99). Fagan’s nomogram showed that F18-FDG PET/CT had good clinical utility for recurrent NSCLC diagnosis. There was considerable between-study variability (p=0.02). Funnel plot was asymmetrical, indicating the possibility of publication bias. Conclusion: This meta-analysis found FDG-PET/CT to be highly accurate for identifying NSCLC recurrence. However, more studies assessing this modality across different patient situations is required to strengthen the argument for changing international guidelines and practices.