Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis
Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis
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DOI：
10.1007/s00259-011-1893-y
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发表时间：
2011-11-01
影响因子：
9.1
通讯作者：
Budrukkar, Ashwini
中科院分区：
文献类型：
--
作者：
Gupta, Tejpal;Master, Zubin;Budrukkar, Ashwini
目的 我们的目的是对评估 (18)F-氟脱氧葡萄糖正电子发射断层扫描 (FDG PET) 联合或不联合计算机断层扫描 (CT) 在头颈鳞状细胞癌 (HNSCC) 治疗后反应评估和/或监测成像中的诊断性能的研究进行系统回顾和荟萃分析。 文献是使用适当的关键词来识别相关研究的。诊断测试准确性的指标，即。从个别研究中提取敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)，并使用随机效应模型进行组合，以产生具有 95% 置信区间 (95% CI) 的加权平均汇总估计值。通过荟萃回归探讨治疗后扫描时间、研究质量和 PET 技术进步的影响。结果 荟萃分析共纳入 51 项研究，涉及 2,335 名患者。原发部位治疗后 FDG PET(CT) 的加权平均 (95% CI) 汇总敏感性、特异性、PPV 和 NPV 分别为 79.9% (73.7-85.2%)、87.5% (85.2-89.5%)、58.6% (52.6-64.5%) 和 95.1% (93.5-96.5%)。颈部的类似估计分别为 72.7% (66.6-78.2%)、87.6% (85.7-89.3%)、52.1% (46.6-57.6%) 和 94.5% (93.1-95.7%)。完成确定性治疗后 12 周进行的千分之一扫描，以时间为协变量的荟萃回归分析具有较高的诊断准确性。 结论 治疗后 FDG PET（CT）对 HNSCC 疗效评估和监测成像的总体诊断性能良好，但其 PPV 有点次优。其 NPV 仍然异常高，治疗后扫描呈阴性强烈提示不存在可指导治疗决策的可行疾病。治疗后成像的时机对诊断准确性有显着但中等的影响。
Purpose Our objective was to conduct a systematic review and meta-analysis of studies assessing the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) with or without computed tomography (CT) in post-treatment response assessment and/or surveillance imaging of head and neck squamous cell carcinoma (HNSCC).Methods A systematic search of the indexed medical literature was done using appropriate keywords to identify relevant studies. Metrics of diagnostic test accuracy, viz. sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were extracted from individual studies and combined using a random effects model to yield weighted mean pooled estimates with 95% confidence intervals (95% CI). The impact of timing of post-treatment scan, study quality and advancements in PET technology was explored through meta-regression.Results A total of 51 studies involving 2,335 patients were included in the meta-analysis. The weighted mean (95% CI) pooled sensitivity, specificity, PPV and NPV of post-treatment FDG PET(CT) for the primary site was 79.9% (73.7-85.2%), 87.5% (85.2-89.5%), 58.6% (52.6-64.5%) and 95.1% (93.5-96.5%), respectively. Similar estimates for the neck were 72.7% (66.6-78.2%), 87.6% (85.7-89.3%), 52.1% (46.6-57.6%) and 94.5% (93.1-95.7%), respectively. Scans done a parts per thousand yen12 weeks after completion of definitive therapy had moderately higher diagnostic accuracy on meta-regression analysis using time as a covariate.Conclusion The overall diagnostic performance of post-treatment FDG PET(CT) for response assessment and surveillance imaging of HNSCC is good, but its PPV is somewhat suboptimal. Its NPV remains exceptionally high and a negative post-treatment scan is highly suggestive of absence of viable disease that can guide therapeutic decision-making. Timing of post-treatment imaging has a significant, though moderate impact on diagnostic accuracy.