The Diagnostic Accuracy Of Bone Scintigraphy, Pet And PET/CT In The Detection Of Bone Metastases From Lung Cancer: A Meta-Analysis

PURPOSE: To perform a meta-analysis to evaluate the diagnostic accuracy of bone scintigraphy, PET and PET/CT in the detection of bone metastases in patients with lung cancer.MATERIALS AND METHODS: English language studies about the accuracy of bone scan, PET or PET/CT in the detection of bone metastases in lung cancer patients were searched in the PUBMED and EMBASE databases from January 1990 to March 2010. The software called Meta-Disc was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR), respectively. Summary receiver operating characteristic (SROC) curves, areas under curve (AUC) and the Q* index were calculated and used to evaluated the diagnostic efficiency of the 3 methods.RESULTS: Seventeen articles fulfilled our inclusion criteria. There were 29 studies including 13 studies of bone scan (2388 patients), 9 studies of PET (1302 patients) and 7 studies of PET/CT (2145 patients). The pooled sensitivity estimates of bone scan, PET and PET/CT were 0.764, 0.909 and 0.924, respectively. The pooled specificity estimates were 0.881, 0.956 and 0.976, respectively. The areas under the SROC curve were 0.9133 for bone scan,0.9357 for PET and 0.9843 for PET/CT. The Q* index estimates were 0.8457,0.9766 and 0.9843, respectively. The Q* index estimates for PET and PET/CT were higher than for bone scan (P<0.05). There were no statistical difference between PET and PET/CT (P>0.05).CONCLUSION: Bone scintigraphy, PET and PET/CT all have good diagnostic performance in the detection of bone metastases in patients with lung cancer. The diagnostic accuracy of PET and PET/CT were higher than that of bone scintigraphy. There were no statistical difference between PET and PET/CT,and further clinical studies are needed to confirm it.