Can 18F-FDG PET/CT predict EGFR status in patients with non-small cell lung cancer? A systematic review and meta-analysis

BMJ Open. 2021 Jun 8;11(6):e044313. doi: 10.1136/bmjopen-2020-044313.

Abstract

Objectives: This study aimed to explore the diagnostic significance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT for predicting the presence of epidermal growth factor receptor (EGFR) mutations in patients with non-small cell lung cancer (NSCLC).

Design: A systematic review and meta-analysis.

Data sources: The PubMed, EMBASE and Cochrane library databases were searched from the earliest available date to December 2020.

Eligibility criteria for selecting studies: The review included primary studies that compared the mean maximum of standard uptake value (SUVmax) between wild-type and mutant EGFR, and evaluated the diagnostic value of 18F-FDG PET/CT using SUVmax for prediction of EGFR status in patients with NSCLC.

Data extraction and synthesis: The main analysis was to assess the sensitivity and specificity, the positive diagnostic likelihood ratio (DLR+) and DLR-, as well as the diagnostic OR (DOR) of SUVmax in prediction of EGFR mutations. Each data point of the summary receiver operator characteristic (SROC) graph was derived from a separate study. A random effects model was used for statistical analysis of the data, and then diagnostic performance for prediction was further assessed.

Results: Across 15 studies (3574 patients), the pooled sensitivity for 18F-FDG PET/CT was 0.70 (95% CI 0.60 to 0.79) with a pooled specificity of 0.59 (95% CI 0.52 to 0.66). The overall DLR+ was 1.74 (95% CI 1.49 to 2.03) and DLR- was 0.50 (95% CI 0.38 to 0.65). The pooled DOR was 3.50 (95% CI 2.37 to 5.17). The area under the SROC curve was 0.68 (95% CI 0.64 to 0.72). The likelihood ratio scatter plot based on average sensitivity and specificity was in the lower right quadrant.

Conclusion: Meta-analysis results showed 18F-FDG PET/CT had low pooled sensitivity and specificity. The low DOR and the likelihood ratio scatter plot indicated that 18F-FDG PET/CT should be used with caution when predicting EGFR mutations in patients with NSCLC.

Keywords: genetics; nuclear radiology; respiratory tract tumours.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Carcinoma, Non-Small-Cell Lung* / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • ErbB Receptors / genetics
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms* / diagnostic imaging
  • Lung Neoplasms* / genetics
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Radiopharmaceuticals
  • Sensitivity and Specificity

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • EGFR protein, human
  • ErbB Receptors