18F-氟脱氧葡萄糖正电子发射断层扫描评估头颈部鳞状细胞癌患者颈部淋巴结转移：一项荟萃分析

18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with head and neck squamous cell carcinoma: a meta-analysis.

作者信息

Kyzas Panayiotis A, Evangelou Evangelos, Denaxa-Kyza Despina, Ioannidis John P A

机构信息

Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece.

出版信息

J Natl Cancer Inst. 2008 May 21;100(10):712-20. doi: 10.1093/jnci/djn125. Epub 2008 May 13.

DOI:10.1093/jnci/djn125

PMID:18477804

Abstract

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.

摘要

背景

正电子发射断层扫描使用18F-氟脱氧葡萄糖（18F-FDG PET）已被提议用于加强对头颈部鳞状细胞癌（HNSCC）患者颈部淋巴结状态的术前评估。对于临床颈部阴性（cN0）的患者，治疗方案最具争议性。我们旨在评估18F-FDG PET在检测HNSCC患者淋巴结转移方面的诊断准确性。

方法

我们对所有关于18F-FDG PET在HNSCC患者中诊断性能的可用研究进行了荟萃分析。我们确定了各项研究的敏感性和特异性，计算了阳性和阴性似然比（LR+和LR-），并使用分层回归模型构建了汇总受试者工作特征曲线。我们还通过分析那些也对同一患者使用了这些诊断方法的研究，比较了18F-FDG PET与传统诊断方法（即计算机断层扫描、磁共振成像和细针穿刺超声）的性能。

结果

在32项研究（1236例患者）中，18F-FDG PET的敏感性为79%（95%置信区间[CI]=72%至85%），特异性为86%（95%CI=83%至89%）。对于cN0患者，18F-FDG PET的敏感性仅为50%（95%CI=37%至63%），而特异性为87%（95%CI=76%至93%）。总体而言，LR+为5.84（95%CI=4.59至7.42），LR-为0.24（95%CI=0.17至0.33）。在同时进行18F-FDG PET和传统诊断测试的研究中，18F-FDG PET的敏感性和特异性分别为80%和86%，传统诊断测试的敏感性和特异性分别为75%和79%。