Potential value of dual-time-point ¹⁸F-FDG PET compared with initial single-time-point imaging in differentiating malignant from benign pulmonary nodules: A systematic review and meta-analysis

We performed a meta-analysis to assess the potential value of dual-time-point (DTP) imaging as compared with initial single-time-point (STP) scanning with F-fluorodeoxyglucose (F-FDG) PET in differentiating malignant from benign single pulmonary nodules. Data on the performance of DTP F-FDG PET imaging in assessing lung nodules were extracted from articles of prospective or retrospective original research published between January 2001 and April 2010. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to assess the quality of study methodology. Heterogeneity in the results of the studies was assessed, and summary receiver operating characteristic (SROC) curves were constructed. Eleven studies comprising a total of 788 patients who underwent initial scanning, 778 of whom also underwent DTP imaging, were included in the final analysis. The quality of study methodology was judged to be moderate. Substantial heterogeneity in the results of the studies, with inconsistency (I) index values above 85%, reflected important differences in study methods and populations, including varying lesion sizes, F-FDG avidity, uptake interval for delayed imaging, and threshold for positive result on DTP imaging. SROC curve analysis revealed a statistically nonsignificant trend toward higher sensitivity with DTP imaging, at moderate levels of specificity, when compared with initial STP scanning. The area under the curve (SE) values for DTP and initial STP imaging were 0.839 (0.079) and 0.757 (0.074), respectively. Although the results of our analysis do not support the routine use of DTP imaging with F-FDG PET in the differential diagnosis of pulmonary nodules, this technique may provide additional information in selected cases with equivocal results from initial scanning. Further prospective research is required to better define the potential benefits of DTP F-FDG PET imaging.