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. 2024 Nov 8;10(22):e40291.
doi: 10.1016/j.heliyon.2024.e40291. eCollection 2024 Nov 30.

Effects of amide proton transfer imaging in diagnosis, grading and prognosis prediction of cervical cancer: A systematic review and meta-analysis

Chongshuang Yang  1   2 , Hasyma Abu Hassan  1 , Nur Farhayu Omar  1 , Tze Hui Soo  1 , Ahmad Shuib Bin Yahaya  3 , Tianliang Shi  2 , Yinbin Luo  2 , Min Wu  2
Affiliations

Effects of amide proton transfer imaging in diagnosis, grading and prognosis prediction of cervical cancer: A systematic review and meta-analysis

Chongshuang Yang et al. Heliyon. .

Abstract

Purpose: To assess the effectiveness of Amide Proton Transfer (APT) imaging in predicting the histopathological characteristics of cervical cancer.

Methods: A comprehensive literature search was conducted across multiple databases, covering studies until December 27, 2023. The meta-analysis was performed using Stata 15 and Review Manager 5.4 software. Key metrics analyzed included pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves. The analysis focused on differentiating cervical cancer types, squamous carcinoma differentiation, and lymph node involvement. Meta-regression was employed to investigate heterogeneity.

Results: Thirteen studies involving 868 patients were included in the meta-analysis. For differentiating adenocarcinoma from squamous carcinoma, the pooled sensitivity was 0.82 (95%CI: 0.71-0.90), specificity was 0.65 (95%CI: 0.48-0.79), and DOR was 9 (95%CI: 1.6-3.5). When distinguishing poorly differentiated from moderately/well-differentiated squamous carcinoma, the sensitivity was 0.74 (95%CI: 0.66-0.81), specificity was 0.83 (95%CI: 0.75-0.89), and DOR was 14 (95%CI: 8-23). For identifying lymph node involvement, the sensitivity was 0.87 (95%CI: 0.78-0.92), specificity was 0.66 (95%CI: 0.59-0.73), and DOR was 13 (95%CI: 7-26). No publication bias was detected.

Conclusions: APT imaging demonstrates high sensitivity and specificity in distinguishing between cervical cancer types, grading squamous carcinoma, and detecting lymph node involvement. It can be considered a reliable technique for predicting the pathological features of cervical cancer in clinical practice.

Keywords: Amide proton transfer; Cervical cancer; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram showing the process for selecting studies.
Fig. 2
Fig. 2
Bias risk assessment results of included studies.
Fig. 3
Fig. 3
Risk of bias and applicability concerns summary.
Fig. 4
Fig. 4
Forest plot of sensitivity and specificity for assessment of Cervical squamous cell carcinoma and adenocarcinoma.
Fig. 5
Fig. 5
ROC curve. (a) ROC curve of APT distinguishing between cervical adenocarcinoma and squamous cell carcinoma; (b) ROC curve for APT to distinguish between low-differentiation and medium-differentiation of cervical squamous cell carcinoma; (c) ROC curve for APT to distinguish cervical cancer lymph node invasion.
Fig. 6
Fig. 6
Forest plot of sensitivity and specificity for assessment of low and moder-high differentiation in cervical squamous cell carcinoma.
Fig. 7
Fig. 7
Forest plot of sensitivity and specificity for assessment of Lymphatic invasion.
Fig. 8
Fig. 8
Deck's funnel diagram. (a) Funnel plot for APT to distinguish between cervical adenocarcinoma and squamous cell carcinoma; (b) funnel-shaped pattern of APT distinguishing between low-differentiation and medium-differentiation of cervical squamous cell carcinoma; (c) Funnel plot of APT to distinguish cervical cancer. lymph node invasion.
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