Positron emission tomography/computed tomography outperforms MRI in the diagnosis of local recurrence and residue of nasopharyngeal carcinoma: An update evidence from 44 studies

Abstract

Studies on nasopharyngeal carcinoma (NPC) in five electronic databases were systematically searched online from the inception to June 5, 2018. Quality of the included studies was assessed using the updated Quality Assessment of Diagnostic Accuracy Studies 2. Data of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the 95% confidence intervals were pooled using a bivariate random-effect model. Forty-four studies with 61 groups of data and totally 3369 patients were included in the qualitative and quantitative synthesis analysis. The overall estimated sensitivity and specificity of positron emission tomography/computed tomography/magnetic resonance imaging (PET-CT/MRI) for local recurrent/residual NPC were 0.90 and 0.85, respectively. The pooled area under the curve of (AUC) of PET-CT/MRI in the summary receiver operator characteristic curve was 0.94. Subgroup analysis showed MRI vs PET-CT had lower sensitivity (0.83 vs 0.92) and specificity (0.78 vs 0.89). The AUCs of MRI and PET-CT were 0.87 and 0.96, respectively. No-cross of 95% CI was found in MRI vs PET/CT (0.87-0.90 vs 0.94-0.98). Meta-regression showed PET/CT vs MRI was a potential source of heterogeneity. PET/CT and MRI both showed quite high overall ability in diagnosing local recurrent/residual NPC, but the subgroup analysis indicated PET-CT was superior over MRI in diagnosis of local recurrence and residue of NPC after radiotherapy. The examination methods affected the heterogeneity within studies.

Keywords: magnetic resonance imaging; nasopharyngeal carcinoma; positron emission tomography/computed tomography; recurrence/residue; sensitivity; specificity.