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. 2018 Nov;10(11):6066-6076.
doi: 10.21037/jtd.2018.10.57.

Systematic review and meta-analysis of the accuracy of 18F-FDG PET/CT for detection of regional lymph node metastasis in esophageal squamous cell carcinoma

Chenxue Jiang  1 , Yun Chen  1 , Yaoyao Zhu  1 , Yapping Xu  1
Affiliations

Systematic review and meta-analysis of the accuracy of 18F-FDG PET/CT for detection of regional lymph node metastasis in esophageal squamous cell carcinoma

Chenxue Jiang et al. J Thorac Dis. 2018 Nov.

Abstract

Background: We performed a systematic review and meta-analysis to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography with computer tomography (18F-FDG PET/CT) for detection of regional lymph node metastasis in esophageal squamous cell carcinoma in per-patient and per-nodal station basis.

Methods: Electronic databases were researched for studies assessing the sensitivity and specificity of PET/CT to detect the regional lymph node metastasis published between January 2006 and December 2017 on esophageal squamous cell carcinoma. STATA software was performed to assess the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd ratio (DOR) and summary receiver operating characteristic (SROC) curve. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Deeks' Funnel Plot Asymmetry Test were performed to evaluate the study quality and publication bias of included studies.

Results: Nineteen studies were eligible for meta-analysis, comprising 1,089 patients with esophageal cancer who underwent 18F-FDG PET/CT before surgery. According to the content of the article, we divided the selected studies into per-patient basis group and per-nodal basis group (one of the articles was involved in both groups). For the per-nodal station basis group (12 studies, 5,681 stations), the pooled sensitivity and specificity estimates of 18F-FDG PET/CT for detecting regional lymph node metastasis were 66% [95% confidence interval (CI): 51-78%] and 96% (95% CI: 92-98%), respectively. The corresponding values on a per-patient basis group (8 studies; 506 patients) were 65% (95% CI: 49-78%) and 81% (95% CI: 69-89%) in sensitivity and specificity, respectively.

Conclusions: Overall, 18F-FDG PET/CT have a moderate to low sensitivity and a high to moderate specificity for detection of regional nodal metastasis in esophageal cancer. Therefore, since the false rate is considerable, extending the extent of lymph node dissection or radiotherapy target volume is necessary after diagnosis of regional nodal metastasis by 18F-FDG PET/CT.

Keywords: Esophageal squamous cell carcinoma; meta-analysis; positron emission tomography with computer tomography (PET/CT); regional lymphatic metastasis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flow chart of the search for eligible studies.
Figure 2
Figure 2
The quality assessment of 19 included studies by QUADAS-2 tool. QUADAS-2, The Quality Assessment of Diagnostic Accuracy Studies 2.
Figure 3
Figure 3
Deek’s funnel plot and sensitivity analysis of 19 included studies. (A,C) On per-patient basis subgroup; (B,D) on per-nodal station basis subgroup.
Figure 4
Figure 4
The forest plot of sensitivity and specificity (A) and SROC curve (B) for 18F-FDG PET/CT in the detection of regional lymph node metastasis in patients with esophageal cancer on per-patient basis. (Number in B represented included studies, sequence is shown in A). SROC, summary receiver operating characteristic; 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography with computer tomography.
Figure 5
Figure 5
The forest plot of sensitivity and specificity (A) and SROC curve (B) for 18F-FDG PET/CT in the detection of regional lymph node metastasis in patients with esophageal cancer on per-nodal station basis. (Number in B represented included studies, sequence is shown in A). SROC, summary receiver operating characteristic; 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography with computer tomography.
Figure S1
Figure S1
The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).
See this image and copyright information in PMC

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