Goense Lucas, Meziani Jihane, van Rossum Peter S N, Wessels Frank J, Meijer Gert J, Lam Marnix G E H, van Hillegersberg Richard, Ruurda Jelle P
Departments of Surgery.
Radiation Oncology.
Nucl Med Commun. 2018 Jul;39(7):645-651. doi: 10.1097/MNM.0000000000000847.
To assess the additional value of cervical ultrasonography as supplement to a negative fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) for detecting cervical lymph node metastases during the initial staging of patients with esophageal cancer.
PubMed/Medline, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies describing the accuracy of cervical ultrasonography and integrated F-FDG PET/CT or standalone F-FDG PET and CT for detecting cervical lymph node metastases in patients with esophageal cancer. The reference standard consisted of cytopathology and/or clinical follow-up. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of the included studies. A random effects model was used to meta-analyze the additional diagnostic value of cervical ultrasonography.
Four diagnostic studies were eligible and included for meta-analysis, comprising 567 patients with esophageal cancer who underwent diagnostic workup before treatment. The quality of the included studies was considered reasonable; there were few concerns regarding risk of bias and applicability. In three of the four studies, cervical ultrasonography did not detect cervical lymph node metastases in addition to a negative finding on F-FDG PET/CT or standalone F-FDG PET and CT. In one study, cervical ultrasonography detected additional cervical lymph node metastases in 4% (3/74) of patients over standalone F-FDG PET and CT. Pooled estimate of the additional value of cervical ultrasonography was 1% (95% confidence interval: 0-5%).
Cervical ultrasonography has very limited additional diagnostic value as supplement to a negative F-FDG PET/CT in the detection of cervical lymph node metastases during the initial staging of patients with esophageal cancer.
评估颈部超声作为氟代脱氧葡萄糖（F-FDG）正电子发射断层显像/计算机断层扫描（PET/CT）阴性结果的补充手段，在食管癌患者初始分期时检测颈部淋巴结转移的附加价值。
系统检索PubMed/Medline、Embase和Cochrane图书馆。分析纳入了描述颈部超声以及F-FDG PET/CT联合或单独的F-FDG PET和CT检测食管癌患者颈部淋巴结转移准确性的诊断研究。参考标准包括细胞病理学和/或临床随访。采用诊断准确性研究质量评估-2工具评估纳入研究的质量。使用随机效应模型对颈部超声的附加诊断价值进行荟萃分析。
四项诊断研究符合纳入标准并用于荟萃分析，共纳入567例在治疗前接受诊断检查的食管癌患者。纳入研究的质量被认为合理；对偏倚风险和适用性的担忧较少。在四项研究中的三项中，颈部超声除了F-FDG PET/CT或单独的F-FDG PET和CT检查结果为阴性外，未检测到颈部淋巴结转移。在一项研究中，与单独的F-FDG PET和CT相比，颈部超声在4%（3/74）的患者中检测到了额外的颈部淋巴结转移。颈部超声附加价值的合并估计值为1%（95%置信区间：0-5%）。
在食管癌患者初始分期时，颈部超声作为F-FDG PET/CT阴性结果的补充手段，在检测颈部淋巴结转移方面的附加诊断价值非常有限。
