CT 和 MRI 诊断头颈部鳞状细胞癌患者结外侵犯的诊断性能：系统评价和诊断荟萃分析。
The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis.
机构信息
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
出版信息
Eur Radiol. 2021 Apr;31(4):2048-2061. doi: 10.1007/s00330-020-07281-y. Epub 2020 Sep 19.
OBJECTIVE
To review the diagnostic performance of CT and MRI for detecting extranodal extension (ENE) in head and neck squamous cell carcinoma (HNSCC) patients.
METHODS
MEDLINE and EMBASE databases were searched up to October 7, 2019. Studies that evaluated the diagnostic performance of CT and/or MRI for detecting ENE in HNSCC patients were included. A 2 × 2 table was reconstructed for each study. Pooled sensitivity and specificity were calculated using the bivariate model and hierarchical summary receiver operating characteristic (HSROC) model. Subgroup analyses were performed according to HPV status and radiological features. Pooled correlation coefficient for interobserver agreement was calculated.
RESULTS
Twenty-two studies including 2478 patients were included. The pooled sensitivity and specificity for detecting ENE were 73% (95% CI, 62-82%) and 83% (95% CI, 75-89%), respectively, for CT, and 60% (95% CI, 49-70%) and 96% (95% CI, 85-99%), respectively, for MRI. There was substantial heterogeneity for both CT and MRI. A threshold effect was present for MRI. On subgroup analysis, the pooled specificity of CT was significantly lower in patients with HPV+ OPSCC than in patients with HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%; p = 0.01). Central node necrosis showed significantly higher pooled sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed significantly higher pooled specificity (94% vs. 65%; p = 0.03). The pooled correlation coefficient was 0.72 (95% CI, 0.60-0.81).
CONCLUSION
Both CT and MRI show reasonable diagnostic performance for detecting ENE in HNSCC patients and interobserver agreement was substantial.
KEY POINTS
• Pooled sensitivity and specificity were 73% and 83% for CT and 60% and 96% for MRI without significant difference. • Pooled specificity was lower for HPV+ OPSCC than for HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%, p = 0.01), likely due to central node necrosis. • Central node necrosis showed higher sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed higher specificity (94% vs. 65%; p = 0.03).
目的
回顾 CT 和 MRI 检测头颈部鳞状细胞癌（HNSCC）患者结外侵犯（ENE）的诊断性能。
方法
检索 MEDLINE 和 EMBASE 数据库，截至 2019 年 10 月 7 日。纳入评估 CT 和/或 MRI 检测 HNSCC 患者 ENE 诊断性能的研究。为每个研究重建 2×2 表。使用双变量模型和分层汇总受试者工作特征（HSROC）模型计算合并的敏感性和特异性。根据 HPV 状态和影像学特征进行亚组分析。计算观察者间一致性的合并相关系数。
结果
共纳入 22 项研究，共计 2478 例患者。CT 检测 ENE 的合并敏感性和特异性分别为 73%（95%CI，62-82%）和 83%（95%CI，75-89%），MRI 分别为 60%（95%CI，49-70%）和 96%（95%CI，85-99%）。CT 和 MRI 均存在较大的异质性。MRI 存在阈值效应。亚组分析显示，HPV+ OPSCC 患者 CT 检测的特异性明显低于 HPV-口腔癌或所有 HNSCC 患者（74%比 87%；p=0.01）。中央区坏死显示出明显更高的合并敏感性（81%比 51%；p=0.02），而相邻平面浸润显示出明显更高的合并特异性（94%比 65%；p=0.03）。合并相关系数为 0.72（95%CI，0.60-0.81）。
结论
CT 和 MRI 对头颈部鳞状细胞癌患者的 ENE 检测均具有较好的诊断性能，观察者间一致性较好。
关键点
CT 的合并敏感性和特异性分别为 73%和 83%，MRI 分别为 60%和 96%，两者无显著差异。
HPV+ OPSCC 患者的 CT 检测特异性明显低于 HPV-口腔癌或所有 HNSCC 患者（74%比 87%，p=0.01），可能与中央区坏死有关。
中央区坏死显示出更高的敏感性（81%比 51%，p=0.02），而相邻平面浸润显示出更高的特异性（94%比 65%，p=0.03）。
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