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Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: a systematic review and meta-analysis

Yi Gong, Qingming Wang, Li Dong, Yiping Jia, Chengge Hua, Fanglin Mi _ and Chunjie Li

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Oncotarget. 2017; 8:14107-14125. https://doi.org/10.18632/oncotarget.12959

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Abstract

Yi Gong1,*, Qingming Wang2,*, Li Dong3, Yiping Jia4, Chengge Hua5, Fanglin Mi6 and Chunjie Li7

1 Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

2 Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

3 Department of Cardiology, The Second Affiliated Hospital of Southwest Medical University, Lu Zhou, Sichuan, China

4 Department of Ultrasound, No.4 West China Teaching Hospital, Sichuan University, Chengdu, China

5 Department of Oral and Maxillofacial Surgery, Department of Evidence-based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China

6 Department of Stomatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China

7 Department of Head and Neck Oncology, Department of Evidence-based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China

* These authors are co-first authors of this article

Correspondence to:

Fanglin Mi, email:

Chunjie Li, email:

Keywords: imaging technique; pelvic lymph node; metastasis; gynecological malignance; systematic review and meta-analysis

Received: August 02, 2016 Accepted: October 22, 2016 Published: October 27, 2016

Abstract

Objective: This study aimed to evaluate the diagnostic performance of different imaging techniques and the corresponding diagnostic criteria for preoperative detection of pelvic lymph node metastasis from gynecological carcinomas.

Methods: Six databases were systematically searched for retrieving eligible studies. Study inclusion, data extraction and risk of bias assessment were performed by 2 reviewers independently. STATA 14.0 was used to perform the meta-analysis. Results: Eighty eligible studies were collected. The pooled sensitivity, specificity, and area under curve (AUC) of CT, MRI and DWI were 47%, 93%, 0.7424; 50%, 95%, 0.8039 and 84%, 95%, 0.9523 respectively. As regards PET, PET-CT and US, the pooled sensitivity, specificity and AUC were 56%, 97%, 0.9592; 68%, 97%, 0.9363 and 71%, 99%, 0.9008 respectively. The summary receiver operating characteristic (SROC) curve indicated that the systematic diagnostic performances of PET, PET-CT, DWI were superior to other imaging modalities.

Conclusions: The present work demonstrated that DWI, PET, PET-CT were the top-priority consideration of imaging modalities for detecting metastatic pelvic lymph node in gynecological carcinoma. DWI was recommended as the first choice for metastasis exclusion and all the other imaging techniques including CT and MRI were suitable for metastasis conformation. However, for the early stage lymph node malignancy, PET or PET-CT could represent a better choice. More studies exploring the diagnostic efficacy of detailed criteria are required in the future.


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