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

Abstract

ObjectiveThis 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.MethodsSix 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.ConclusionsThe 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.

Individualized pelvic lymphadenectomy should follow neoadjuvant concurrent chemoradiotherapy for locally advanced cervical cancer

“…Klerkx et al [ 25 ] have concluded that best sensitivity and specificity rates are acquired when short axis diameter of pelvic LN on the MR image is >8 mm, resulting in a sensitivity of 42.9% and specificity 96.6%. In one meta-analysis [ 26 ] , the authors recommended LN diameter ≥8 mm as the best cut-off value when short axis diameter was adopted as a positive criterion in MRI examination. According to the above research, we classified the patients into 2 groups: enlarged LN short diameter <0.8 cm, and enlarged short diameter ≥0.8 cm.…”

Diagnostik und Staging gynäkologischer Tumoren mittels MRT

“…Nierenhilus mit einbezogen werden. Die Diffusionswichtung ist bei der Sensitivität des Nachweises von Lymphknotenmetastasen der konventionellen MRT überlegen (p = 0,0006) bei vergleichbarer Spezifität (p = 1,00) [26]. Bei der Befundung der DWI sollte immer eine T2w oder T1w Sequenz mitbetrachtet werden, da auch normale Lymphknoten aufgrund ihre hohen Zelldichte eine relative Diffusionsrestriktion aufweisen und damit ebenfalls ein hohes Signal bei hohem b-Wert mit korrespondierender ADC-Absenkung zeigen [27].…”

Current FIGO Staging for Carcinoma of the Cervix Uteri and Treatment of Particular Stages

“…Při zhodno cení LN pomocí zobrazovacích metod kolísá senzitivita (záchyt pozitivních LN) detekce postižených LN podle růz ných studií mezi 60-88 % se specificitou (počet falešně pozitivně hodnocených LN) dosahující až 97 % [5,15]. Recentní metaanalýza zjistila při hodnocení stavu LN nejvyšší specificitu pro ultrazvu kové vyšetření (99 %) ve srovnání s PET CT (97 %), MRI (95 %) a CT (93 %) [19]. Infiltrované LN jsou často < 5-10 mm, což je velká limitace pro MRI i PETCT, proto je senzitivita těchto vyšetření rela tivně malá a zvyšuje se až u pokročilých onemocnění [14,15].…”