| Purpose:Head and neck cancer have a high propensity for developing distant metastasis and a second primary cancer . Early diagnosis is essential for precise M staging, optimal management, and accurate comparison of protocol efficacies in patients with advanced disease.Whole-body PET and PET-CT are promising tools in the early diagnosis of distant metastasis or a second primary cancer in patients with head and neck cancer before treatment. We conducted a meta-analysis to evaluate the value of whole-body PET and PET-CT in initial M staging of head and neck cancer.Methods:Studies about the accuracy of PET or PET-CT in determining initial M staging of head and neck cancer were systematically searched in the MEDLINE, EMBASE, and the Cochrane Database of Systematic Review from January 1, 2000 to September 31, 2009. Two reviewers independently searched articles and extracted data. A software called"Meta-DiSc"was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristic (SROC) curves, and the Q* index, respectively.Results: Twelve articles met our inclusion criteria and were selected, including seven PET-CT studies (797 patients) and eight PET studies (795 patients).209 (14.4%) of 1445 eiligble patient in the selected studies have distant metastasis or a second primary cancer. The pooled sensitivity, specificity and DOR, PLR, and NLR with 95% of confidence interval of whole-body PET were 0.848(0.776–0.905), 0.952 (0.933–0.967), 107.23 (59.255–194.04), 17.401 (12.161–24.899), and 0.170 (0.116–0.249), respectively. The pooled sensitivity, specificity, DOR, PLR, and NLR with 95% of confidence interval of whole -body PET-CT were 0.875 (0.787–0.936), 0.950 (0.931–0.964), 174.24(77.109–393.72), 16.653 (11.996–23.117), and 0.141 (0.083– 0.238), respectively.The Q* index estimates for PET-CT (0.9409) were not significantly higher than for PET (0.9154) (p>0.05).Conclusions: Whole-body PET-CT and PET have higher diagnostic value in determining initial M staging of head and neck cancer; Both have similar diagnostic accuracy. But PET-CT tends to have higher accuracy than PET. A negative examination result of PET or PET-CT cann't be used alone as a justification to rule out distant metastasis or a second primary cancer. Purpose:FDG-PET and PET-CT are promising imaging tools in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. We conducted a meta-analysis to evaluate the value of FDG PET/PET-CT in prediction of necessity for neck dissection for head and neck cancer after radiotherapy.Methods:A computer search about PET/PET-CT original articles from January 1990 to January 2010 was conducted. The reference standard was histop–athologic analysis and/or close clinical and imaging follow-up. Two reviewers independently searched articles and extracted data. Sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were pooled using the bivariate model. Hierarchical summary receiver operating characteristic (HSROC) curves were also used to summarize overall test performance.Results:Thirteen articles met our inclusion criteria and were selected, including fourteen PET/PET-CT studies. 111 (14.7%) of 745 eiligble patient in the selected studies have the residual or recurrence of lymph nodes after radiotherapy. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio with 95% of confidence interval for PET/PET-CT was 0.876 (0.759-0.940),0.891(0.777-0.951), 57.712(13.465 -247.355),8.047(3.547 -18.257) and 0.139(0.065-0.298), respectively.Conclusions: FDG PET/PET-CT had higher accuracy in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. A negative examination result of PET or PET-CT couldn't be used alone as a justification to rule out neck dissection for head and neck cancer after radiotherapy.
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