Contrast-enhanced computed tomography versus positron emission tomography/positron emission tomography-computed tomography in suspected lung cancer: a systematic review and meta-analysis of diagnostic accuracy studies.

BACKGROUND

There is uncertainty regarding the optimal next imaging modality for identifying likely malignant pulmonary lesions in patients with abnormal chest radiography, with or without respiratory symptoms.

OBJECTIVES

We compared the diagnostic accuracy of chest contrast-enhanced computed tomography (CECT) and positron emission tomography or positron emission tomography-computed tomography (PET/PET-CT) for identifying malignant pulmonary lesions.

DESIGN

Systematic review and meta-analysisData sources and methods:We searched the PubMed, Embase, Scopus, and Cochrane CENTRAL databases to identify head-to-head diagnostic accuracy studies comparing CECT and PET/PET-CT for their ability to differentiate between benign and malignant pulmonary lesions. The risk of bias of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies - Comparative (QUADAS-C) tool. Meta-analysis was performed using the bivariate random effects model.

RESULTS

We included eight studies, comprising a total of 873 subjects. The pooled sensitivity and specificity of CECT (850 lesions) were 0.93 (95% CI, 0.89-0.96; I2 = 24.99%) and 0.54 (95% CI, 0.32-0.75; I2 = 84.00%). The pooled sensitivity and specificity of PET/PET-CT (851 lesions) were 0.87 (95% CI, 0.78-0.93; I2 = 65.15%) and 0.83 (95% CI, 0.63-0.94; I2 = 73.23%). Compared to CECT, PET/PET-CT had a lower relative sensitivity (relative ratio [RR], 0.93; 95% CI, 0.89-0.97; p < 0.01) and a higher relative specificity (RR, 1.69; 95% CI, 1.18-2.41; p < 0.01). After excluding the study with the largest sample size, PET/PET-CT was not less sensitive than CECT (RR, 0.99; 95% CI, 0.94-1.04; p = 0.73). There was a high/unclear risk of bias and applicability concerns in the population domain in six out of eight studies.

CONCLUSIONS

Based on limited evidence with applicability concerns, CECT of the chest may have a higher sensitivity but lower specificity than PET/PET-CT for identifying malignant lesions among patients with suspected lung cancer.

TRIAL REGISTRATION: The protocol for the systematic review was prospectively registered on PROSPERO (CRD42024590904).