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. 2017 Sep 19;8(48):84473-84488.
doi: 10.18632/oncotarget.21055. eCollection 2017 Oct 13.

Comparison of DWI and 18F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis

Mingxu Luo  1 , Hongmei Song  2 , Gang Liu  1 , Yikai Lin  3 , Lintao Luo  1 , Xin Zhou  1 , Bo Chen  1   4
Affiliations

Comparison of DWI and 18F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis

Mingxu Luo et al. Oncotarget. .

Abstract

The diagnostic values of diffusion weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for N-staging of gastric cancer (GC) were identified and compared. After a systematic search to identify relevant articles, meta-analysis was used to summarize the sensitivities, specificities, and areas under curves (AUCs) for DWI and PET/CT. To better understand the diagnostic utility of DWI and PET/CT for N-staging, the performance of multi-detector computed tomography (MDCT) was used as a reference. Fifteen studies were analyzed. The pooled sensitivity, specificity, and AUC with 95% confidence intervals of DWI were 0.79 (0.73-0.85), 0.69 (0.61-0.77), and 0.81 (0.77-0.84), respectively. For PET/CT, the corresponding values were 0.52 (0.39-0.64), 0.88 (0.61-0.97), and 0.66 (0.62-0.70), respectively. Comparison of the two techniques revealed DWI had higher sensitivity and AUC, but no difference in specificity. DWI exhibited higher sensitivity but lower specificity than MDCT, and 18F-FDG PET/CT had lower sensitivity and equivalent specificity. Overall, DWI performed better than 18F-FDG PET/CT for preoperative N-staging in GC. When the efficacy of MDCT was taken as a reference, DWI represented a complementary imaging technique, while 18F-FDG PET/CT had limited utility for preoperative N-staging.

Keywords: diffusion weighted imaging; gastric cancer; lymph node staging; positron emission tomography/computed tomography.

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Conflict of interest statement

CONFLICTS OF INTEREST None.

Figures

Figure 1
Figure 1. Flow diagram of literature search and study selection
Figure 2
Figure 2. Quality assessment of included studies using QUADAS-2
(A) For DWI studies; (B) For 18F-FDG PET/CT studies.
Figure 3
Figure 3. Forest plots of DWI and 18F-FDG PET/CT in evaluating preoperative N-staging in patients with gastric cancer
(A) Pooled sensitivity of DWI; (B) Pooled specificity of DWI; (C) Pooled sensitivity of 18F-FDG PET/CT; (D) Pooled specificity of 18F-FDG PET/CT.
Figure 4
Figure 4. The summary ROC curves of DWI and 18F-FDG PET/CT in evaluating preoperative N-staging in patients with gastric cancer
(A) For DWI; (B) For 18F-FDG PET/CT .
Figure 5
Figure 5. Univariable meta-regression & subgroups analyses of diagnostic performance of 18F-FDG PET/CT
(Abbreviations: GE = American General Corporation; QL = qualitative analysis; QN = quantitative analysis).
Figure 6
Figure 6. Deeks’ funnel plot asymmetry tests for assessing potential publication bias
(A) For DWI; (B) For 18F-FDG PET/CT.
See this image and copyright information in PMC

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