Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: a systematic review and meta-analysis

Abstract

J Sun,1 B Li,2 CJ Li,1 Y Li,1 F Su,3 QH Gao,4 FL Wu,4 T Yu,5 L Wu,6 LJ Li11Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People’s Republic of China; 2West China School of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People’s Republic of China; 3Department of stomatology, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China; 4Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China; 5Department of Head and Neck Oncology Surgery, Sichuan Cancer Hospital, Chengdu, People’s Republic of China; 6Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USAAbstract: Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods to detect cervical lymph node metastasis of head and neck cancer. We aimed to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis, and to establish unified diagnostic criteria via systematic review and meta-analysis. A systematic literature search in five databases until January 2014 was carried out. All retrieved studies were reviewed and eligible studies were qualitatively summarized. Besides pooling the sensitivity (SEN) and specificity (SPE) data of CT and MRI, summary receiver operating characteristic curves were generated. A total of 63 studies including 3,029 participants were involved. The pooled results of meta-analysis showed that CT had a higher SEN (0.77 [95% confidence interval {CI} 0.73–0.87]) than MRI (0.72 [95% CI 0.70–0.74]) when node was considered as unit of analysis (P<0.05); MRI had a higher SPE (0.81 [95% CI 0.80–0.82]) than CT (0.72 [95% CI 0.69–0.74]) when neck level was considered as unit of analysis (P<0.05) and MRI had a higher area under concentration-time curve than CT when the patient was considered as unit of analysis (P<0.05). With regards to diagnostic criteria, for MRI, the results showed that the minimal axial diameter of 10 mm could be considered as the best size criterion, compared to 12 mm for CT. Overall, MRI conferred significantly higher SPE while CT demonstrated higher SEN. The diagnostic criteria for MRI and CT on size of metastatic lymph nodes were suggested as 10 and 12 mm, respectively.Keywords: computed tomography, magnetic resonance imaging, metastasis, head and neck cancer, meta-analysis