Diagnostic significance of diffusion-weighted MRI in patients with cervical cancer: a meta-analysis

Hou, Bo; Xiang, Shijun; Yao, Gen-Dong; Yang, Su-Jun; Zhang, Yixin; Wang, Junwei

doi:10.1007/s13277-014-2290-5

Cited by 17 publications

(6 citation statements)

References 39 publications

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“…To the best of our knowledge, this paper is the first and most comprehensive meta-analysis for the diagnostic performance of CT, PET/CT, MRI, and DWI-MRI for detecting LN metastases in cervical cancer patients. From 2010 to now, there are 4 meta-analysis papers focusing on this subject [8,9,72,73] , but our meta-analysis is the first one to comprehensively compare and diagnose efficacies of the 4 modalities.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Gao²,

Li³

2017

Gynecol Obstet Invest

159

105

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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.

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Section: Discussionmentioning

confidence: 99%

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

Liu

Gao²,

Li³

2017

Gynecol Obstet Invest

159

105

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“…When compared with the conventional T1-or T2-weighted sequences, the diffusion-restricted tumor is more conspicuous against the normal tissue and is especially useful when gadolinium-based contrast agent cannot be administered. Similarly, intrauterine tumor growth, lymph node metastases, and peritoneal carcinomatosis are more reliably depicted with diffusion-weighted imaging than with conventional noncontrast sequences (37,43,44). The derived apparent diffusion coefficients offer an opportunity for quantitative imaging but have yet to be incorporated into clinical examination protocols (45).…”

Section: Choice Of Imaging and Staging Pitfallsmentioning

confidence: 99%

2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging

2019

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ynecologic cancers are staged according to the International Federation of Gynecology and Obstetrics (FIGO) system (1). Although a parallel TNM system for gynecologic cancers has been described by the American Joint Committee on Cancer, the FIGO system continues to predominate worldwide in clinical practice and for cancer database reporting (2). The first staging system put forth by FIGO around the turn of the 20th century applied to carcinoma of the uterine cervix, at the time the most common cancer among women in the developed world (3). The most recent revision of the FIGO staging system was announced in 2018 (Table 1). Whereas FIGO staging of most gynecologic cancers relies on surgery and pathologic analysis, uterine cervical cancer is unusual among the gynecologic cancers in that it is staged clinically with pelvic examination, often under anesthesia with bladder cystoscopy and colposcopy, in combination with imaging. Preceding versions of the staging system included imaging with chest and skeletal radiography, intravenous pyelography, and barium enema (4-6). These low-technology choices reflected the demographic reality that nearly 85% of invasive cervical cancer is diagnosed in low-resource settings where advanced imaging modalities are unavailable. Staging according to the old systems (ie, FIGO cervical staging systems from 1999, 2009, and 2014) was inaccurate, with 20%-40% of stage IB-IIIB cancers understaged and up to 64% of stage IIIB cancers overstaged (7-9). Older systems did not include assessment of lymph node metastases, an important determinant for prognosis and treatment planning. Moreover, radical trachelectomy, an emerging fertility-preserving technique in which the uterine corpus is anastomosed to the vagina to treat the many women diagnosed during their reproductive years, was not a consideration with these older systems. To compensate for these shortfalls, treatment planning for invasive cervical cancer in much of the developed world has included modern cross-sectional and functional imaging such as CT, MRI, and fluorine 18 fluorodeoxyglucose, or FDG, PET (10,11). Such pretreatment imaging spared many women the particularly toxic combination of surgery, followed by concurrent chemotherapy and radiation therapy. Instead, they are triaged to one or the other curative, and far less morbid, options (12). The revisions introduced in the 2018 FIGO staging system are intended to address the gap between the staging formalism and ongoing clinical practice and to explicitly acknowledge the role that advanced imaging has come to play in the care of women with invasive uterine cervical cancer (13). In this article, we review the 2018 FIGO staging system for cervical cancer and the new additions relevant to radiologists. Imaging modalities for staging in a range of high-to low-resource practice settings are presented. The standards for image acquisition and interpretation are summarized with cases illustrating potential pitfalls. Finally, we describe how the recommended imaging choices can be directly a...

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“…10,40 Traditional size criteria that the short-axis diameter of 10 mm was commonly used as the cut-off for benign and malignant lesions revealed a relevantly low sensitivity. 12,41 DWI that provides information about the integrity of cell membranes and tissue consistency is non-invasive and enables the radiologist to move from morphological to functional assessment of diseases.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis

Shen

Zhou

Jia

et al. 2015

BJR

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In recent years, diffusion-weighted (DW) MRI has emerged as a new technique for detecting the pelvic lymph metastases in patients with cervical cancer. The aim of this meta-analysis was to assess the diagnostic value of DW imaging (DWI) for benign/malignant discrimination of pelvic lymph nodes (LNs). Studies about DWI for the detection of metastatic LNs were searched in the PubMed, EMBASE, Web of Science, EBSCO, the Cochrane Library and three Chinese databases. Based on the extracted data, we determined pooled sensitivities, specificities and diagnostic odds ratios (DORs) across studies, calculated positive and negative likelihood ratios (LRs) and constructed summary receiver operating characteristic curves with area under the curve (AUC) and Q* obtained. We also analysed the heterogeneity between studies based on subgroup analysis, threshold effect and publication bias. In total, 15 studies involving 1021 patients met the inclusion criteria. The pooled sensitivity, specificity and DOR of DWI were 0.86 [95% confidence interval (CI), 0.84-0.89], 0.84 (95% CI, 0.83-0.86) and 47.21 (95% CI, 25.67-86.81), respectively. LR syntheses yielded overall positive LR of 6.55 (95% CI, 4.77-9.01) and negative LR of 0.17 (95% CI, 0.12-0.23). The AUC and Q* index were 0.9384 and 0.8754, respectively. The heterogeneity was relatively high between studies; however, there was no evidence for threshold effect and publication bias. DWI is beneficial in the pelvic nodal assessment in patients with cervical cancer. Large-scale, high-quality trials with standard protocols are required to evaluate its clinical value for discrimination of metastatic from non-metastatic pelvic LNs in patients with cervical cancer. Advances in knowledge include providing evidence to assess the role of DWI in nodal staging of cervical cancer.

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Diagnostic significance of diffusion-weighted MRI in patients with cervical cancer: a meta-analysis

Cited by 17 publications

References 39 publications

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

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

2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging

Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis

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