The diagnostic performance and clinical value of [18F]FDG PET/CT in pleural mesothelioma - A systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of FDG PET/CT for diagnosing pleural mesothelioma in treatment-naïve patients using histopathology as reference standard. Secondary aims include evaluation of FDG PET/CT or FDG PET/MRI's diagnostic accuracy of lymph node and distant metastases, their impact on TNM-staging, and PET uptake and volumetric parameters in pleural mesothelioma.

METHODS

We conducted a systematic review and meta-analysis adhering to 'Preferred Reporting Guidelines for Systematic reviews and Meta-Analyses' (PRISMA) with a predefined literature search. It consisted of the terms: "pleura" or "pleural" or "mesothelioma", "PET" or "positron emission tomography", and "FDG" or "fluorodeoxyglucose". Two independent reviewers systematically screened the literature based on eligibility criteria, extracted data, and evaluated quality of evidence. The meta-analysis was performed using a hierarchical model to estimate pooled diagnostic accuracy parameters. Publication bias was assessed with Deeks' regression test.

RESULTS

Forty-one studies were included; the primary aim was evaluated by a meta-analysis which included 10 studies. Thirty-eight studies were included for evaluating secondary aims. The estimated pooled sensitivity and specificity for FDG PET/CT in differentiating pleural mesothelioma from benign pleural lesions were 0.94 (95%CI: 0.87-0.97) and 0.84 (95%CI: 0.73-0.91), respectively. There was substantial study heterogeneity, but no publication bias was detected.

CONCLUSION

This study shows high sensitivity and specificity of FDG PET/CT for diagnosing pleural mesothelioma. The results are compatible with previous findings and give an updated evidence base to compare diagnostic performance of FDG PET/CT to other imaging modalities e.g. contrast-enhanced CT or PET with novel tracers.