Diffusion-weighted MRI versus PET CT in evaluation of clinically N0 neck in patients with HNSCC : systematic review and meta-analysis study

Abstract EN

Background : Evaluation of a clinically N0 neck is essential in cases of head and neck squamous cell carcinoma (HNSCC) in order to determine whether the neck needs treatment or not.

Purpose : The study was designed to compare the efficacy of DW-MRI with that of PET / CT scans in the preoperative evaluation of clinically N0 neck in cases of HNSCC.

Methods : A systematic search was performed by the Pub Med / MEDLINE to identify and select the relevant studies published within the last 20 years (up to 20 / 01 / 2014).

Reported sensitivities, specificities, Positive Likelihood Ratio, Negative Likelihood Ratio and Diagnostic Odds Ratio were metaanalyzed.

QUADAS criteria were used to evaluate the methodologic quality of the studies.

Results : Six studies met the inclusion criteria and were analyzed.

Only one study evaluated DWMRI whereas 5 studies evaluated PET / CT comprising a total sample size of 329 patients.

Sensitivity was homogeneous across studies (P = 0.202), whereas specificity was heterogeneous across studies (P = 0.050).

The overall sensitivity, specificity and accuracy rates of DW-MRI in evaluation of a clinically N0 neck were 100 %, 71 % and 85 % respectively whereas PET / CT scans’ overall sensitivity, specificity and accuracy were 68 %, 84 % and 78 % respectively.

Conclusions : The available evidence suggests that DWI is more sensitive than PET / CT in the preoperative evaluation of cN0 neck in patients with HNSCC.

PET / CT exam has low sensitivity and a positive test would not help the clinician in the management of the patient with clinically N0 disease and therefore, it should not be routinely used in neck nodal status work-ups.