¹⁸F-FDG PET/CT for the Diagnosis of Residual or Recurrent Nasopharyngeal Carcinoma After Radiotherapy: A Metaanalysis

Abstract

The aim of this work was to assess the overall value of 18 F-FDG PET/ CT in the diagnosis of residual or recurrent nasopharyngeal carcinoma using a metaanalysis. Methods: The literature published between January 1990 and September 2014 was searched in the PubMed, EMBASE, Cochrane Library, EBSCO, VIP, CNKI, and Wanfang databases to identify eligible studies on PET/CT of residual or recurrent lesions. The methodologic quality of the included studies was evaluated using the "quality assessment for studies of diagnostic accuracy" tool. Summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and receiver-operating characteristic curve were obtained using Meta-DiSc freeware. Subgroups were also analyzed. Results: A total of 23 studies, involving 1,253 subjects, were included in the metaanalysis. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, with 95% confidence intervals in parentheses, for 18 F-FDG PET or PET/CT were 0.93 (0.91-0.95), 0.87 (0.84-0.89), 5.52 (3.96-7.71), 0.12 (0.09-0.15), and 55.31 (34.94-87.57), respectively. The area under the receiver-operating characteristic curve and Q* index estimate of PET/CT were 0.9473 and 0.8869, respectively. There was no significant difference between the area under the curve of PET and PET/CT (P . 0.05). Conclusion: Our study has confirmed that 18 F-FDG PET/ CT has high sensitivity and specificity but significant heterogeneity in the diagnosis of residual or recurrent nasopharyngeal carcinoma.

Prognostic value of 18F-FDG-PET/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis

“…Only 4 of these literature were about NPC and they all analysed the accuracy of PET for residual and recurrent NPC or detected the lymph node and distant metastases [53–56]. As far as our information goes, our meta-analysis is the first to assess the prognostic values of 18 F-FDG PET/CT parameters in NPC patients.…”

Value of intravoxel incoherent motion and dynamic contrast-enhanced MRI for predicting the early and short-term responses to chemoradiotherapy in nasopharyngeal carcinoma

“…18 F-Fluoro-deoxy-glucose positron emission tomography ( 18 F-FDG-PET) has been applied in assessing the treatment response for NPC [4] and other tumors such as head and neck squamous cell carcinoma (HNSCC), [5,6] rectal cancer, [7] and breast cancer. [8] However, the complex anatomy of nasopharynx, low spatial resolution, and treatment-induced inflammation may decrease the accuracy of 18 F-FDG-PET.…”

Hopkins criteria for residual disease assessment after definitive radiotherapy in nasopharyngeal carcinoma

“…Although this could be partially explained by the reduction of false positive caused by inflammation, higher prevalence of residual disease after 3‐4 months might also contribute to the higher PPV. PPV of posttherapy PET/CT has been considered suboptimal in HNSCC, and delayed scanning proved little difference …”

“…Meta-analysis suggests that PET/CT enjoyed higher specificity and diagnostic odds ratio in the diagnosis of residual/recurrent NPC compared with MRI, but heterogeneity exists in test characteristics (threshold, comparator, reference standard, timing, etc). 3,4 Given the potential benefits, Hopkins criteria were introduced into the posttreatment assessment of HSNCC to standardize the interpretation. 5 Subsequent studies showed a reduction of equivocal results and improved consistency using this scoring system.…”