比较CT、MRI、PET-CT和超声在检测头颈部鳞状细胞癌临床颈部淋巴结阴性患者颈部淋巴结转移中的疗效：一项系统评价和荟萃分析。
Comparing the Efficacy of CT, MRI, PET-CT, and US in the Detection of Cervical Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma with Clinically Negative Neck Lymph Node: A Systematic Review and Meta-Analysis.
作者信息
Alsibani Ahmed, Alqahtani Abdulwahed, Almohammadi Roaa, Islam Tahera, Alessa Mohammed, Aldhahri Saleh F, Al-Qahtani Khalid Hussain
机构信息
Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh 11411, Saudi Arabia.
College of Medicine, Taibah University, Madinah 42311, Saudi Arabia.
出版信息
J Clin Med. 2024 Dec 14;13(24):7622. doi: 10.3390/jcm13247622.
Traditional imaging techniques have limited efficacy in detecting occult cervical lymph node (LN) metastases in head and neck squamous cell carcinoma (HNSCC). Positron emission tomography/computed tomography (PET-CT) has demonstrated potential for assessing HNSCC, but the literature on its efficacy for detecting cervical LN metastases is scarce and exhibits varied outcomes, hindering comparisons. To compare the efficacy of CT, MRI, PET-CT, and US for detecting LN metastasis in HNSCC with clinically negative neck lymph nodes. : A systematic search was performed using Web of Science, PubMed, Scopus, Embase, and Cochrane databases. Studies comparing CT, MRI, PET-CT, or US to detect cervical metastases in HNSCC were identified. The quality of the studies was assessed using the QUADAS-2 instrument. The positive likelihood ratios (+LR) and negative likelihood ratios (-LR), sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR), with 95% confidence intervals (C.I.), were calculated. Analysis was stratified according to lymph node and patient basis. Fifty-seven studies yielded 3791 patients. At the patient level, PET-CT exhibited the highest diagnostic performance, with a SEN of 74.5% (95% C.I.: 65.4-81.8%) and SPE of 83.6% (95% C.I.: 77.2-88.5%). PET-CT also demonstrated the highest +LR of 4.303 (95% C.I.: 3.082-6.008) and the lowest -LR of 0.249 (95% C.I.: 0.168-0.370), resulting in the highest DOR of 15.487 (95% C.I.: 8.973-26.730). In the evaluation of diagnostic parameters for various imaging modalities on node-based analysis results, MRI exhibited the highest SEN at 77.4%, and PET demonstrated the highest SPE at 96.6% (95% C.I.: 94.4-98%). PET-CT achieved the highest DOR at 24.353 (95% C.I.: 10.949-54.166). PET-CT outperformed other imaging modalities across the majority of studied metrics concerning LN metastasis detection in HNSCC.
传统成像技术在检测头颈部鳞状细胞癌（HNSCC）隐匿性颈淋巴结（LN）转移方面的效能有限。正电子发射断层扫描/计算机断层扫描（PET-CT）已显示出评估HNSCC的潜力，但关于其检测颈淋巴结转移效能的文献稀少且结果各异，不利于进行比较。为比较CT、MRI、PET-CT和超声在检测临床颈部淋巴结阴性的HNSCC患者LN转移方面的效能：使用Web of Science、PubMed、Scopus、Embase和Cochrane数据库进行了系统检索。纳入比较CT、MRI、PET-CT或超声检测HNSCC颈转移的研究。使用QUADAS-2工具评估研究质量。计算阳性似然比（+LR）、阴性似然比（-LR）、敏感度（SEN）、特异度（SPE）和诊断比值比（DOR）及95%置信区间（C.I.）。分析按淋巴结和患者层面分层。57项研究纳入3791例患者。在患者层面，PET-CT表现出最高的诊断性能，SEN为74.5%（95% C.I.：65.4-81.8%），SPE为83.6%（95% C.I.：77.2-88.5%）。PET-CT还显示出最高的+LR为4.303（95% C.I.：3.082-6.008）和最低的-LR为0.249（95% C.I.：0.168-0.370），从而得出最高的DOR为15.487（95% C.I.：8.973-26.730）。在基于淋巴结分析结果对各种成像模态的诊断参数评估中，MRI的SEN最高，为77.4%，PET的SPE最高，为96.6%（95% C.I.：94.4-98%）。PET-CT的DOR最高，为24.353（95% C.I.：10.949-54.166）。在大多数关于HNSCC LN转移检测的研究指标中，PET-CT的表现优于其他成像模态。
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