Health Economics Research Group, Brunel University, Middlesex, UK.
BJOG. 2014 Mar;121(4):398-407. doi: 10.1111/1471-0528.12488. Epub 2013 Dec 3.
Positron emission tomography-computed tomography (PET-CT) is recommended to triage women for exenterative surgery and surveillance after treatment for advanced cervical cancer.
To evaluate diagnostic accuracy of additional whole body PET-CT compared with CT/magnetic resonance imaging (MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance.
Systematic reviews. Subjective elicitation to supplement diagnostic information.
SEARCH STRATEGY/SELECTION CRITERIA/DATA COLLECTION AND ANALYSIS: Searches of electronic databases were performed to June 2013. Studies in women with suspected recurrent/persistent cervical cancer and in asymptomatic women undergoing follow up with sufficient numeric data were included. We calculated sensitivity, specificity and corresponding 95% confidence intervals. Meta-analyses employed a bivariate model that included a random-effects term for between-study variations (CT studies) and univariate random effects meta-analyses (PET-CT studies) for sensitivity and specificity separately.
Prevalence of recurrence and the accuracy of imaging elicited using the allocation of points technique. Coherence of elicited subjective probabilities with estimates in the literature examined.
We identified 15 relevant studies; none directly compared additional PET-CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET-CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET-CT were less than elicited increases required to justify the use in PET-CT for surveillance.
Evidence to support additional PET-CT is scarce, of average quality and does not distinguish between application for surveillance and diagnosis. Guidelines recommending PET-CT in recurrent cervical cancer need to be reconsidered in the light of the existing evidence base.
正电子发射断层扫描-计算机断层扫描（PET-CT）被推荐用于对接受治疗后的晚期宫颈癌患者进行子宫切除术和随访的分诊。
评估全身附加 PET-CT 相对于 CT/磁共振成像（MRI）单独检查对疑似复发性/持续性宫颈癌和无症状妇女进行随访的诊断准确性。
系统评价。主观启发以补充诊断信息。
检索策略/选择标准/数据收集和分析：对电子数据库进行了搜索，截止到 2013 年 6 月。纳入了有疑似复发性/持续性宫颈癌和无症状妇女进行随访的研究，这些研究有足够的数值数据。我们计算了敏感性、特异性和相应的 95%置信区间。荟萃分析采用了包含研究间差异（CT 研究）的双变量模型和分别对敏感性和特异性进行的单变量随机效应荟萃分析。
使用点数分配技术获得复发的患病率和影像学的准确性。对启发式主观概率与文献中检查的估计值的一致性进行检查。
我们确定了 15 项相关研究；没有一项直接比较附加的 PET-CT 与 MRI 或 CT。大多数 CT 和 MRI 研究使用的是旧协议，且大多数研究没有区分无症状和有症状的妇女。对 9 项主要针对有症状妇女的 PET-CT 研究进行荟萃分析显示，敏感性为 94.8%（95%CI 91.2-96.9），特异性为 86.9%（95%CI 82.2-90.5）。CT 检测复发的敏感性汇总估计值为 89.64%（95%CI 81.59-94.41），特异性为 76%（95%CI 43.68-92.82）。由于临床异质性，对 MRI 检测准确性研究进行荟萃分析是不可能的。MRI 在盆腔复发中的敏感性和特异性分别在 82%至 100%和 78%至 100%之间变化。不可能对指标检测的准确性进行正式的统计学比较。主观启发提供的估计值与文献相符。从添加 PET-CT 中获得的准确性提高的主观估计值低于启发式增加所需的值，不足以证明 PET-CT 用于监测的合理性。
支持附加 PET-CT 的证据很少，质量一般，并且不能区分监测和诊断的应用。鉴于现有的证据基础，需要重新考虑推荐在复发性宫颈癌中使用 PET-CT 的指南。
