Journal of the National Cancer Institute Advance Access published online on May 13, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn125
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© The Author 2008. Published by Oxford University Press.
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18F-Fluorodeoxyglucose Positron Emission Tomography to Evaluate Cervical Node Metastases in Patients With Head and Neck Squamous Cell Carcinoma: A Meta-analysis
Affiliations of authors: Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece (PAK, DDK, EE, JPAI); Department of Oral and Maxillofacial Surgery, Ninewells Hospital, NHS Tayside, Scotland, UK (PAK); Biomedical Research Institute, Foundation for Research and Technology-Hellas, Ioannina, Greece (JPAI); Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center, Boston, MA (JPAI)
Correspondence to: John P. A. Ioannidis, MD, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece (e-mail: jioannid{at}cc.uoi.gr).
Background: Positron emission tomography using 18F-fluorodeoxyglucose (18F-FDG PET) has been proposed to enhance preoperative assessment of cervical lymph node status in patients with head and neck squamous cell carcinoma (HNSCC). Management is most controversial for patients with a clinically negative (cN0) neck. We aimed to assess the diagnostic accuracy of 18F-FDG PET in detecting lymph node metastases in patients with HNSCC.
Methods: We performed a meta-analysis of all available studies of the diagnostic performance of 18F-FDG PET in patients with HNSCC. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), and constructed summary receiver operating characteristic curves using hierarchical regression models. We also compared the performance of 18F-FDG PET with that of conventional diagnostic methods (ie, computed tomography, magnetic resonance imaging, and ultrasound with fine-needle aspiration) by analyzing studies that had also used these diagnostic methods on the same patients.
Results: Across 32 studies (1236 patients), 18F-FDG PET sensitivity was 79% (95% confidence interval [CI] = 72% to 85%) and specificity was 86% (95% CI = 83% to 89%). For cN0 patients, sensitivity of 18F-FDG PET was only 50% (95% CI = 37% to 63%), whereas specificity was 87% (95% CI = 76% to 93%). Overall, LR+ was 5.84 (95% CI = 4.59 to 7.42) and LR– was 0.24 (95% CI = 0.17 to 0.33). In studies in which both 18F-FDG PET and conventional diagnostic tests were performed, sensitivity and specificity of 18F-FDG PET were 80% and 86%, respectively, and of conventional diagnostic tests were 75% and 79%, respectively.
Conclusion: 18F-FDG PET has good diagnostic performance in the overall pretreatment evaluation of patients with HNSCC but still does not detect disease in half of the patients with metastasis and cN0.
| CONTEXT AND CAVEATS Prior knowledge Knowing whether or not cancer has spread to lymph nodes in the neck is important for the prognosis and treatment of patients with head and neck squamous cell carcinoma (HNSCC). Positron emission tomography using 18F-fluorodeoxyglucose (18F-FDG PET) has been proposed as a diagnostic method for this assessment. Study design Meta-analysis of studies reporting the diagnostic performance of 18F-FDG PET to detect lymph node metastasis in the necks of patients with HNSCC. Sensitivity and specificity of 18F-FDG PET were compared with those of other diagnostic methods, including computed tomography and magnetic resonance imaging. Contributions 18F-FDG PET performed well in sensitivity and specificity analyses overall and was comparable to or slightly better than the other diagnostic methods compared. However, 18F-FDG PET detected only half of the neck metastases in HNSCC patients with metastases who were clinically diagnosed as lymph node negative. Implications 18F-FDG PET has limited diagnostic performance in the evaluation of neck metastasis in patients with HNSCC, and its routine use in pretreatment evaluation of these patients is not supported. Limitations Few HNSCC patients who had been clinically diagnosed as node negative were available for the analysis. In many studies, the interpretation of the 18F-FDG PET scans was qualitative and not blinded.
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Manuscript received November 27, 2007; revised February 21, 2008; accepted March 20, 2008.
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J Natl Cancer Inst 2008 100: 688-689.
J Natl Cancer Inst 2008 100: 687.
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