Mimoun Camille, Rouzier Roman, Benifla Jean Louis, Fauconnier Arnaud, Huchon Cyrille
Department of Gynecology and Obstetrics, Lariboisiere Hospital, University of Paris, 75010 Paris, France.
Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University of Versailles Saint-Quentin (UVSQ), 78180 Poissy, France.
Diagnostics (Basel). 2021 Sep 23;11(10):1748. doi: 10.3390/diagnostics11101748.
In advanced epithelial ovarian cancer (EOC), the LION trial restricted lymphadenectomy indication to patients with suspect lymph nodes before and during surgery. Preoperative imaging is used to assess lymph node status, and particularly CT and PET/CT. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of preoperative CT and PET/CT to detect lymph node metastasis (LNM) in patients with EOC; Methods: Databases were searched from January 1990 to May 2019 for studies that evaluated the diagnostic accuracy of preoperative CT and PET/CT to detect LNM in patients with EOC with histology as the gold standard. Pooled diagnostic accuracy was calculated using bivariate random-effects models and hierarchical summary receiver operating curve (HSROC). This study is registered with PROSPERO number CRD42020179214; Results: A total of five studies were included in the meta-analysis: four articles concerned preoperative CT and four articles concerned preoperative PET/CT, involving 106 and 138 patients, respectively. For preoperative CT, pooled sensitivity was 0.47 95% CI [0.20-0.76], pooled specificity was 0.99 95% CI [0.75-1.00] and area under the curve (AUC) of the HSROC was 0.91 95% CI [0.88-0.93]. For preoperative PET/CT, pooled sensitivity was 0.81 95% CI [0.61-0.92], pooled specificity was 0.96 95% CI [0.91-0.99] and AUC of the HSROC was 0.97 95% CI [0.95-0.98]; Conclusions: PET/CT has a very high diagnostic accuracy, especially for specificity, to detect LNM in EOC and should be realized systematically, additionally to CT recommended to evaluate peritoneal spread, in the preoperative staging of patients with an advanced disease.
在晚期上皮性卵巢癌（EOC）中，LION试验将淋巴结清扫术的指征限制为手术前及手术过程中怀疑有淋巴结转移的患者。术前影像学检查用于评估淋巴结状态，尤其是CT和PET/CT。本系统评价和荟萃分析的目的是评估术前CT和PET/CT检测EOC患者淋巴结转移（LNM）的诊断准确性；方法：检索1990年1月至2019年5月的数据库，查找以组织学为金标准评估术前CT和PET/CT检测EOC患者LNM诊断准确性的研究。使用双变量随机效应模型和分层汇总接受者操作特征曲线（HSROC）计算合并诊断准确性。本研究已在PROSPERO注册，注册号为CRD42020179214；结果：荟萃分析共纳入五项研究：四项文章涉及术前CT，四项文章涉及术前PET/CT，分别涉及106例和138例患者。对于术前CT，合并敏感性为0.47，95%CI[0.20-0.76]，合并特异性为0.99，95%CI[0.75-1.00]，HSROC曲线下面积（AUC）为0.91，95%CI[0.88-0.93]。对于术前PET/CT，合并敏感性为0.81，95%CI[0.61-0.92]，合并特异性为0.96，95%CI[0.91-0.99]，HSROC的AUC为0.97，95%CI[0.95-0.98]；结论：PET/CT在检测EOC的LNM方面具有非常高的诊断准确性，尤其是特异性，在晚期疾病患者的术前分期中，除了推荐用于评估腹膜播散的CT外，还应系统地应用PET/CT。
