18F-FDG PET/CT for predicting major pathological response to neoadjuvant therapy in non-small cell lung cancer: a meta-analysis

Objective To comprehensively evaluate the diagnostic utility of metabolic parameter changes on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting pathological response after neoadjuvant therapy in patients with non-small cell lung cancer (NSCLC). Methods The Cochrane Library, Web of Science, Embase, and PubMed were comprehensively retrieved up until October 2024 to identify diagnostic test accuracy studies evaluating the predictive efficacy of 18F-FDG PET/CT for postoperative pathological response in NSCLC patients following neoadjuvant therapy. Two independent reviewers screened studies, collected information, and evaluated the risk of bias. Statistical analysis was conducted via Meta-Disc 1.4 and Stata 17.0 software. Results Fourteen eligible investigations encompassing 1,315 subjects were incorporated. The findings revealed that for predicting major pathological response (MPR) after neoadjuvant therapy, the metabolic parameter ΔSUVmax% on 18F-FDG PET/CT achieved an area under the summary receiver operating characteristic curve (sAUC) of 0.96 (95% CI: 0.94-0.97), with pooled sensitivity and specificity of 0.87 (0.73-0.94) and 0.93 (0.84-0.97), respectively. Similarly, the parameter SUVmax itself yielded an sAUC of 0.95 (0.93-0.96), with sensitivity of 0.80 (0.63-0.91) and specificity of 0.94 (0.87-0.97). Stratified analyses indicated that the neoadjuvant treatment regimen (single-modality vs. combination therapy), the cut-off value (55% vs. ≥55%), sample size (40 vs. ≥40), and the proportion of adenocarcinoma in the study sample (40% vs. ≥40%) were potential sources of heterogeneity. Conclusion Quantitative metabolic metrics derived from 18F-FDG PET/CT (ΔSUVmax% and SUVmax) demonstrate high diagnostic performance for pathological response after neoadjuvant therapy in NSCLC. These metrics may serve as noninvasive adjunct tools for response assessment, supporting individualized neoadjuvant strategies and facilitating clinical trial design in the perioperative immunotherapy era. However, given the limited number and quality of the available studies, these findings require confirmation through high-quality research. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024612056.