Impact of 18F-FDG PET/CT in Staging Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis
Francesco Martucci, Mariarosa Pascale, Maria Carla Valli, Gianfranco Pesce, Patrizia Froesch, Luca Giovanella, A. Richetti, Giorgio Treglia
Abstract
Background Molecular imaging methods are currently used in the management of patients with lung cancer. Compared to non-small cell lung cancer (NSCLC), less data are available about the impact of molecular imaging by using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging patients with small cell lung cancer (SCLC). Performing a systematic review and meta-analysis we aimed to provide quantitative data about the impact of 18F-FDG PET/CT in staging SCLC. Methods A comprehensive literature search of studies on the use of 18F-FDG PET/CT in patients with SCLC was performed. Three different databases were screened (PubMed/MEDLINE, EMBASE and Cochrane library databases) until June 2019. Only articles describing the impact of 18F-FDG PET/CT in staging patients with SCLC were selected. A pooled analysis evaluating the change of binary SCLC staging (limited-stage versus extensive-stage disease) by using 18F-FDG PET/CT was carried out. Results Nine articles including 721 patients with SCLC were included in the systematic review. Compared to conventional staging, a superior diagnostic accuracy of 18F-FDG PET/CT was found. A change of binary SCLC staging by using 18F-FDG PET/CT was demonstrated in 15% (95% confidence interval: 9-21%) of patients with SCLC. Currently, it is not clearly demonstrated that the use of 18F-FDG PET/CT for staging may improve the survival outcome of patients with SCLC. Conclusions 18F-FDG PET/CT is a useful molecular imaging method for staging patients with SCLC because it can change the management in a significant number of patients. More large prospective studies and cost-effectiveness analyses on the impact of 18F-FDG PET/CT in staging patients with SCLC are needed.