Because of an estimated 20–30% prevalence of occult lymph node (LN) metastases in patients with head and neck squamous cell carcinoma (HNSCC), neck dissection is often proposed, despite its potential morbidity. In this systematic review and meta-analysis, the diagnostic performance of FDG PET-CT in detecting occult LN metastases was evaluated in patients with clinically negative necks (cN0) and in whom histopathology of a neck dissection specimen served as gold standard. Overall, 16 studies out of 2062 screened on PubMed and EMBASE fulfilled the inclusion criteria (n = 1148 patients). Seven of these sixteen studies were split into two or three studies because they contained data that could be processed distinctly in our meta-analysis. For this reason, a total of 25 studies were identified and included in the analysis (n total = 1918 patients). The overall prevalence of metastatic nodes per patient was 22.67%. The pooled sensitivity, specificity, diagnostic odds ratios, and negative predictive value (NPV) were 0.71 (95%CI: 0.66–0.75), 0.90 (95%CI: 0.84–0.93), 20.03 (95%CI: 13.51–29.70), and 0.92 (95%CI: 0.89–0.95), respectively. The main causes of inter-study heterogeneity included different reference standards (evaluation per patient, per neck side, or per neck level). The current meta-analysis showed that FDG PET-CT has a high specificity and NPV for ruling out nodal involvement in cN0 necks, but a limited sensitivity.
鉴于头颈部鳞状细胞癌（HNSCC）患者中隐匿性淋巴结转移的预估发生率约为20%至30%，尽管颈部清扫术可能带来一定的并发症风险，临床上仍常建议采用该手术。本系统性综述与荟萃分析旨在评估FDG PET-CT在临床颈部阴性（cN0）患者中检测隐匿性淋巴结转移的诊断效能，并以颈部清扫标本的组织病理学结果为金标准。通过对PubMed和EMBASE数据库的2062篇文献进行筛选，最终有16项研究符合纳入标准（共1148例患者）。由于其中7项研究包含的数据可在荟萃分析中独立处理，故将其拆分为两项或三项独立研究。因此，最终共纳入25项研究进行分析（总计1918例患者）。患者隐匿性淋巴结转移的总体发生率为22.67%。汇总的敏感性、特异性、诊断比值比及阴性预测值分别为0.71（95%CI：0.66–0.75）、0.90（95%CI：0.84–0.93）、20.03（95%CI：13.51–29.70）和0.92（95%CI：0.89–0.95）。研究间异质性的主要来源包括不同的参考标准（按患者、按颈侧或按颈部区域进行评估）。当前荟萃分析表明，FDG PET-CT在排除cN0颈部淋巴结转移方面具有较高的特异性和阴性预测值，但其敏感性有限。
肿瘤(癌症)患者之家