Comparing the Efficacy of CT, MRI, PET-CT, and US in the Detection of Cervical Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma with Clinically Negative Neck Lymph Node: A Systematic Review and Meta-Analysis

• Published in: Journal of Clinical Medicine 2024, Vol.13 (24)
• Main Authors: Alsibani, Ahmed, Alqahtani, Abdulwahed, Almohammadi, Roaa, Islam, Tahera, Alessa, Mohammed, Aldhahri, Saleh F, Al-Qahtani, Khalid Hussain
• Format: Report
• Language: English
• Subjects: Cervical cancer; Comparative analysis; Diagnosis; Diagnostic imaging; Head and neck cancer; Lymphatic metastasis
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13247622

Background: Traditional imaging techniques have limited efficacy in detecting occult cervical lymph node (LN) metastases in head and neck squamous cell carcinoma (HNSCC). Positron emission tomography/computed tomography (PET-CT) has demonstrated potential for assessing HNSCC, but the literature on its efficacy for detecting cervical LN metastases is scarce and exhibits varied outcomes, hindering comparisons. Aim: To compare the efficacy of CT, MRI, PET-CT, and US for detecting LN metastasis in HNSCC with clinically negative neck lymph nodes. Methods : A systematic search was performed using Web of Science, PubMed, Scopus, Embase, and Cochrane databases. Studies comparing CT, MRI, PET-CT, or US to detect cervical metastases in HNSCC were identified. The quality of the studies was assessed using the QUADAS-2 instrument. The positive likelihood ratios (+LR) and negative likelihood ratios (−LR), sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR), with 95% confidence intervals (C.I.), were calculated. Analysis was stratified according to lymph node and patient basis. Results: Fifty-seven studies yielded 3791 patients. At the patient level, PET-CT exhibited the highest diagnostic performance, with a SEN of 74.5% (95% C.I.: 65.4–81.8%) and SPE of 83.6% (95% C.I.: 77.2–88.5%). PET-CT also demonstrated the highest +LR of 4.303 (95% C.I.: 3.082–6.008) and the lowest −LR of 0.249 (95% C.I.: 0.168–0.370), resulting in the highest DOR of 15.487 (95% C.I.: 8.973–26.730). In the evaluation of diagnostic parameters for various imaging modalities on node-based analysis results, MRI exhibited the highest SEN at 77.4%, and PET demonstrated the highest SPE at 96.6% (95% C.I.: 94.4–98%). PET-CT achieved the highest DOR at 24.353 (95% C.I.: 10.949–54.166). Conclusions: PET-CT outperformed other imaging modalities across the majority of studied metrics concerning LN metastasis detection in HNSCC.