A Comprehensive Comparison of CT, MRI, Positron Emission Tomography or Positron Emission Tomography/CT, and Diffusion Weighted Imaging-MRI for Detecting the Lymph Nodes Metastases in Patients with Cervical Cancer: A Meta-Analysis Based on 67 Studies

Abstract

Object: In recent times, many published papers reported the diagnostic performance of CT, MRI, positron emission tomography (PET) using 2-[¹⁸F] fluoro-2-deoxy-D-glucose (FDG) and diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting the lymph nodes (LNs) metastases in patients with cervical cancer. This study is aimed at assessing and comparing the diagnostic value of those non-invasive modalities in detecting the LNs metastases in cervical cancer patients. Methods: Studies on the non-invasive modalities for the detection of metastatic LNs were searched in PubMed, Medline, Web of Science, Cochrane Library and Embase databases. Pooled positive likelihood ratios and negative likelihood ratios, diagnostic OR, area under curve (AUC), summary receiver operating characteristics were calculated as evaluation indices. Results: In region- or node-based analysis, the AUC of DWI-MRI (0.92) and PET or PET/CT (0.90) were better than CT (0.83), and the difference was significant (DWI-MRI vs. CT: Z = 4.61, p < 0.001; PET or PET/CT vs. CT: Z = 3.61, p = 0.001). Conclusion: Among the 4 non-invasive modalities, the PET or PET/CT has the highest specificity, and DWI-MRI has the highest sensitivity.

Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status

“…There are variable accuracy and CT had > 90% specificity and < 60% sensitivity, indicating that CT had high specificity in the detection of LNM. The sensitivity and specificity of MRI were 54% and 93%, respectively [5].…”

How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?

“…70 In a meta-analysis evaluating performance of different imaging modalities for lymph nodes metastasis in cervical cancer, DWI had higher sensitivity compared with CT, positron emission tomography/CT, and MRI without DWI. 80 It should be noted that some normal lymph nodes show restricted diffusion similar to malignant involvement. 70 However, the high signal in lymph nodes on higher b value DWI, whether they are benign or malignant makes them more conspicuous than on other sequences, and they may have been not detected on the other sequences although frequently can be seen in retrospect.…”

A Pilot Study on Diagnostic Performance of Contrast-Enhanced Ultrasonography for Detection of Early Cervical Cancer

“…However, FDG PET/CT has limited value in the primary staging of low volume local disease in patients with early stage cervical cancer, even when micro-metastases are present (108). According to a meta-analysis from 2017 the accuracy for detecting lymph nodes metastasis with PET/CT (n=22 studies) is higher in advanced stage disease as compared to early stage disease (AUC 0.95 versus AUC 0.76, p = 0.03) (109). In Sweden PET/CT is recommended as a complementary examination for patients where advanced disease is suspected.…”