The Accuracy Of PET/CT, CT, MRI For Metastatic Lymph Nodes In Patients With Cervical Cancer:a Meta-analysis

Objective To assess the accuracy of CT, MRI, PET/CT for metastatic lymph nodes in patients with cervical cancer.Methods We systematic searched PubMed(1966-2013.7),EMBASE.com (1974-2013.7),Web of Science(1980-2013.7),The Cochrane Library(-2013.7),Chinese Scientific Journals Fulltext Database(1989-2013.7),WanFang Database(1997-2013.7),China National Knowledge Infrastructure(1994-2013.7) and Chinese Biomedical Literature Database(1978-2013.7),meanwhile the manual and other retrieves were also conducted for including to relevant literature of CT, MRI, PET/CT in the diagnosis of cervical lymph node metastasis. All studies were independently reviewed and selected by two evaluators. QUADAS items were used to evaluate the quality of included studies. Meta Disc version1.4and STATA version12.0software was used to handle data for included studies. We estimated a summary receiver operating characteristic (SROC) curve. The area under the curve (AUC) was calculated. The sensitivity, specificity, positive LR, negative LR, SROC, pre-test probability, post-test probability were used to assess the diagnostic value of individual diagnostic test.Results We searched for1016records,82studies of them met the eligible criteria, involved16030patients.31studies for CT,26studies for MRI,25studies for PET/CT. Meta analysis showed:①The heterogeneity existed between studies(P=0.00,12>50%), we used random effects model to do data merging.Compared with surgical pathologic,which used considered as gold standard,CT indicated a higher level in overall sensitivity (0.73,95%CI:0.69,0.76), specificity (0.91,95%CI:0.90,0.92),+LR (5.66,95%CI:4.02,7.98),-LR(0.39,95%CI:0.29,0.53),DOR(18.22,95%CI:11.40,29.11), AUC(0.91,95%CI:0.88,0.93)spre-test probability(20.00%),post-test probability (66.00%).②Compared with surgical pathologic,which used considered as gold standard, MRI indicated a higher level in overall sensitivity (0.57,95%CI:0.53,0.61), specificity(0.94,95%CI:0.93,0.95),+LR(5.80,95%CI:4.19,8.02),-LR(0.47,95%CI:0.39,0.57),DOR(14.67,95%CI:9.36,22.98),AUC(0.84,95%CI:0.81,0.87),pre-test probability(20.00%),post-test probability(59.00%).③Compared with surgical pathologic, which used considered as gold standard, PET/CT indicated a higher level in overall sensitivity (0.73,95%CI:0.70,0.76),specificity(0.96,95%CI:0.95,0.96,+LR(7.66,95%CI:5.20,11.28),-LR(0.34,95%CI:0.27,0.44),DOR(32.56,95%CI:17.46,60.71),AUC(0.92,95%CI:0.90,0.94),pre-test probability(20.00%),post-test probability(73.00%).④SROC showed that the diagnostic value of was PET/CT>CT>MRI。Conclusion The current evidence showed that,compared with CT,the PET/CT has the high specificity,DOR and AUC,compared with MRI,the PET/CT has the high specificity,DOR and AUC.The post-test probability of PET/CT was higher than CT and MRI. The diagnostic value of PET/CT was better than CT and MRI for metastatic lymph nodes in patients with cervical cancer.