Diagnostic Accuracy of18 F-FDG-PET and PET/CT in the Differential Diagnosis between Malignant and Benign Pleural Lesions

Rationale and Objectives To systematically review and meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the differential diagnosis between malignant and benign pleural lesions. Methods and Materials A comprehensive literature search of studies published through June 2013 regarding the diagnostic performance of18 F-FDG-PET and PET/CT in the differential diagnosis of pleural lesions was carried out. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR−) and diagnostic odds ratio (DOR) of18 F-FDG-PET or PET/CT in the differential diagnosis of pleural lesions on a per-patient–based analysis were calculated. The area under the summary receiver operating characteristic curve (AUC) was calculated to measure the accuracy of these methods. Subanalyses considering device used (PET or PET/CT) were performed. Results Sixteen studies including 745 patients were included in the systematic review. The meta-analysis of 11 selected studies provided the following results: sensitivity 95% (95% confidence interval [95%CI]: 92–97%), specificity 82% (95%CI: 76–88%), LR+ 5.3 (95%CI: 2.4–11.8), LR− 0.09 (95%CI: 0.05–0.14), DOR 74 (95%CI: 34–161). The AUC was 0.95. No significant improvement of the diagnostic accuracy considering PET/CT studies only was found. Conclusions18 F-FDG-PET and PET/CT demonstrated to be accurate diagnostic imaging methods in the differential diagnosis between malignant and benign pleural lesions; nevertheless, possible sources of false-negative and false-positive results should be kept in mind.