Jiang Chenxue, Chen Yun, Zhu Yaoyao, Xu Yapping
Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
J Thorac Dis. 2018 Nov;10(11):6066-6076. doi: 10.21037/jtd.2018.10.57.
We performed a systematic review and meta-analysis to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography with computer tomography (18F-FDG PET/CT) for detection of regional lymph node metastasis in esophageal squamous cell carcinoma in per-patient and per-nodal station basis.
Electronic databases were researched for studies assessing the sensitivity and specificity of PET/CT to detect the regional lymph node metastasis published between January 2006 and December 2017 on esophageal squamous cell carcinoma. STATA software was performed to assess the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd ratio (DOR) and summary receiver operating characteristic (SROC) curve. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Deeks' Funnel Plot Asymmetry Test were performed to evaluate the study quality and publication bias of included studies.
Nineteen studies were eligible for meta-analysis, comprising 1,089 patients with esophageal cancer who underwent 18F-FDG PET/CT before surgery. According to the content of the article, we divided the selected studies into per-patient basis group and per-nodal basis group (one of the articles was involved in both groups). For the per-nodal station basis group (12 studies, 5,681 stations), the pooled sensitivity and specificity estimates of 18F-FDG PET/CT for detecting regional lymph node metastasis were 66% [95% confidence interval (CI): 51-78%] and 96% (95% CI: 92-98%), respectively. The corresponding values on a per-patient basis group (8 studies; 506 patients) were 65% (95% CI: 49-78%) and 81% (95% CI: 69-89%) in sensitivity and specificity, respectively.
Overall, 18F-FDG PET/CT have a moderate to low sensitivity and a high to moderate specificity for detection of regional nodal metastasis in esophageal cancer. Therefore, since the false rate is considerable, extending the extent of lymph node dissection or radiotherapy target volume is necessary after diagnosis of regional nodal metastasis by 18F-FDG PET/CT.
我们进行了一项系统评价和荟萃分析，以评估18F-氟脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（18F-FDG PET/CT）在每位患者和每个淋巴结站基础上检测食管鳞状细胞癌区域淋巴结转移的准确性。
检索电子数据库，查找2006年1月至2017年12月期间发表的评估PET/CT检测食管鳞状细胞癌区域淋巴结转移的敏感性和特异性的研究。使用STATA软件评估敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和汇总受试者工作特征（SROC）曲线。采用诊断准确性研究质量评估2（QUADAS-2）和迪克斯漏斗图不对称性检验来评估纳入研究的质量和发表偏倚。
19项研究符合荟萃分析条件，包括1089例术前接受18F-FDG PET/CT检查的食管癌患者。根据文章内容，我们将所选研究分为每位患者基础组和每个淋巴结站基础组（其中一篇文章同时涉及两组）。对于每个淋巴结站基础组（12项研究，5681个淋巴结站），18F-FDG PET/CT检测区域淋巴结转移的合并敏感性和特异性估计值分别为66%[95%置信区间（CI）：51-78%]和96%（95%CI：92-98%）。在每位患者基础组（8项研究；506例患者）中，敏感性和特异性的相应值分别为65%（95%CI：49-78%）和81%（95%CI：69-89%）。
总体而言，18F-FDG PET/CT检测食管癌区域淋巴结转移的敏感性为中度至低度，特异性为高度至中度。因此，由于假阳性率相当可观，在通过18F-FDG PET/CT诊断区域淋巴结转移后，有必要扩大淋巴结清扫范围或放疗靶区。
