Impact of (18)F-FDG PET/CT in Staging Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Background: Molecular imaging methods are currently used in the management of patients with lung cancer. Compared to non-small cell lung cancer, less data are available about the impact of molecular imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-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 (18)F-FDG PET/CT in staging SCLC. Methods: A comprehensive literature search of studies on the use of (18)F-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 (18)F-FDG PET/CT in staging patients with SCLC were selected. A pooled analysis evaluating the change of binary SCLC staging (limited-stage vs. extensive-stage disease) using (18)F-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 (18)F-FDG PET/CT was found. A change of binary SCLC staging using (18)F-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 (18)F-FDG PET/CT for staging may improve the survival outcome of patients with SCLC. Conclusions: (18)F-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 (18)F-FDG PET/CT in staging patients with SCLC are needed.