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Review
. 2024 Apr 10;16(8):1457.
doi: 10.3390/cancers16081457.

A Systematic Review and Meta-Analysis of 29 Studies Predicting Diagnostic Accuracy of CT, MRI, PET, and USG in Detecting Extracapsular Spread in Head and Neck Cancers

Manish Mair  1 , Hitesh Singhavi  2 , Ameya Pai  3 , Mariya Khan  2 , Peter Conboy  1 , Oladejo Olaleye  1 , Rami Salha  4 , Phil Ameerally  4 , Ram Vaidhyanath  5 , Pankaj Chaturvedi  3
Affiliations
Review

A Systematic Review and Meta-Analysis of 29 Studies Predicting Diagnostic Accuracy of CT, MRI, PET, and USG in Detecting Extracapsular Spread in Head and Neck Cancers

Manish Mair et al. Cancers (Basel). .

Abstract

Background: Extracapsular spread (ECS) is the extension of cancer cells beyond the lymph node capsule and is a significant prognostic factor in head and neck cancers. This meta-analysis compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers.

Methodology: The authors conducted a systematic review and meta-analysis of studies that compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. They included studies that were published between 1990 and December 2023 and that used histopathology as the reference standard for ECS.

Results: The pooled sensitivity and specificity of CT scan were 0.63 (95% CI = 0.53-0.73) and 0.85 (95% CI = 0.74-0.91), respectively. The pooled sensitivity and specificity of MRI were 0.83 (95% CI = 0.71-0.90) and 0.85 (95% CI = 0.73-0.92), respectively. The pooled sensitivity and specificity of PET were 0.80 (95% CI = 0.74-0.85) and 0.93 (95% CI = 0.92-0.94), respectively. The pooled sensitivity and specificity of USG were 0.80 (95% CI = 0.68-0.88) and 0.84 (95% CI = 0.74-0.91), respectively. MRI had significantly higher sensitivity than CT scan (p-0.05). The specificity of CT and MRI was not significantly different (p-0.99). PET scan had the highest specificity among all imaging modalities.

Conclusion: MRI is the most accurate imaging modality for detecting ECS in head and neck cancers. CT scan is a reasonable alternative, but PET scan may be considered when high specificity is required. USG may not add any further benefit in detecting ECS.

Keywords: CT; ECS; MRI; PET; USG; accuracy; head and neck cancer; imaging; neck node; sensitivity; specificity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The PRISMA flow diagram.
Figure 2
Figure 2
(a,b) The risk of bias and applicability concerns summary and graph [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,35,36,38,39,40,43].
Figure 3
Figure 3
The forest plots of sensitivities and specificities of the CT scan for diagnosis of ECS [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27].
Figure 4
Figure 4
The pooled estimates of sensitivity and specificity of CT scan for diagnosis of ECS.
Figure 5
Figure 5
Standard summary receiver operating characteristic plot for CT scan. The forest plots of sensitivities and specificities of the MRI scan for diagnosis of ECS [20,25,28,29,30,31,35].
Figure 6
Figure 6
Standard summary receiver operating characteristic plot for MRI scan.
Figure 7
Figure 7
The forest plots of sensitivities and specificities of the PET–CT scan for diagnosis of ECS [38,43].
Figure 8
Figure 8
The forest plots of sensitivities and specificities of the USG scan for diagnosis of ECS [33,35].
See this image and copyright information in PMC

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