Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: Meta‐analysis

Abstract

We performed a meta-analysis to compare diagnostic performances of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET or PET/CT), for detection of metastatic lymph nodes in patients with cervical cancer. We searched MEDLINE (PubMed), EMBASE and the Cochrane Review database in December 2007. All articles were independently reviewed and selected by three evaluators. We estimated a summary receiver operating characteristic (sROC) curve. The area under the curve (AUC), Q*, and pooled weighted estimates of sensitivity and specificity for each modality by patient-based and region-or node-based data analyses and conducted pair-wise comparisons between modalities using the two-sample Z-test. Fortyone of 768 initially identified studies were included in the metaanalysis. In a patient-based data analysis, PET or PET/CT showed the highest pooled sensitivity (82%) and specificity (95%), while CT showed 50% and 92%; and MRI, 56% and 91%, respectively. The AUC (0.9641) and Q* (0.9106) of PET or PET/CT were significantly higher than those of MRI (AUC = 0.8270; Q* = 0.7599), both P < 0.001. In region-or node-based data analysis, sensitivities of CT (52%) and PET or PET/CT (54%) were higher than that of MRI (38%), P < 0.02 and P < 0.001, respectively, while specificities of MRI (97%) and PET or PET/CT (97%) were higher than that of CT (92%), both P < 0.001. The AUC and Q* showed no significant difference among CT, MRI, and PET or PET/CT. PET or PET/CT had an overall higher diagnostic performance than did CT or MRI in detecting metastatic lymph nodes in patients with cervical cancer. (Cancer Sci 2010; 101: 1471-1479 U terine cervical carcinoma is the second most common malignancy in women worldwide, and is the only major gynecologic malignancy that is staged clinically according to International Federation of Obstetrics and Gynecology (FIGO) recommendations.(1) However, clinical staging of cervical cancer is accurate in only 29% of patients. Undiagnosed lymph node metastases are a major problem (2)(3)(4)(5) because lymph node status is an independent prognostic factor for survival of patients with primary cervical cancer.(6-9) Although lymph node dissection before radiotherapy results in improved survival of patients with macroscopically enlarged pelvic and para-aortic lymph nodes, the routine pretreatment surgical staging is not recommended. Thus, an inaccurate evaluation of lymph node metastasis associated with uterine cervical carcinoma often leads to unsatisfactory treatment. (10)(11)(12)(13)(14) Computed tomography (CT) and magnetic resonance imaging (MRI) have been used to assess the metastatic lymph nodes of cervical cancer patients. A meta-analysis of studies evaluating these diagnostic methods concluded that these methods have only moderate sensitivity and specificity for detection of metastatic lymph nodes.(15) On the contrary, the recent studies have reported that positron emission tomography (PET or PET ⁄ CT), employing [18 F]-fluoro-2-deoxy-D-glucose (FDG), is more sensi...

Advanced Imaging Applications for Locally Advanced Cervical Cancer

“…The data of CT, MRI and PET/CT is reviewed in Table 1 and 2. (Nicolet et al, 2000;Narayan et al, 2001;Belhocine et al, 2002;Bipat et al, 2003;Ozsarlak et al, 2003;Hricak et al, 2005;Park et al, 2005;Rockall et al, 2006;Koyama et al, 2007;Hancke et al, 2008;Magne et al, 2008;Choi et al, 2010;HaieMeder et al, 2010;Sharma et al, 2010;Amit et al, 2011;Balleyguier et al, 2011;Bell & Pannu, 2011;Leblanc et al, 2011) …”

The Role of Ultrasound in the Assessment of Uterine Cervical Cancer

“…Currently, MRI for local extent of disease evaluation and PET-scan for distant disease assessment are considered as first-line techniques [5,6]. Notwithstanding, in the last few years, ultrasound has gained attention as an imaging technique for evaluating women with cervical cancer.…”

Terahertz Pulse Imaging of Micro-metastatic Lymph Nodes in Early-stage Cervical Cancer Patients

“…Although PET scanning diagnoses metastatic lymph nodes by assessing the abnormal accumulation of FDG, PET is expensive and less widely available, and has lower spatial resolution. The pooled sensitivities of CT, MRI, and PET were found to be only 52%, 38%, and 54%, respectively, in region-or nodebased comparisons, which are too low to replace surgical staging [19,20]. Thus, there are as-of-yet unmet clinical needs for the accurate imaging diagnosis of metastatic lymph nodes and detection of small metastatic nodes, i.e., diagnoses that better reflect the actual histological processes.…”