Accuracy of 18F-flurodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of newly diagnosed nasopharyngeal carcinoma: a systematic review and meta- analysis

Abstract

Background

The specific role of FDG-PET/CT in staging of nasopharyngeal carcinoma (NPC) remains to be validated. We performed a systematic review and meta-analysis to assess the accuracy of staging FDG-PET/CT for newly diagnosed NPC.

Methods

We searched various biomedical databases and conference proceedings for relevant studies. We determined the pooled sensitivities and specificities, diagnostic odds ratios (DOR) and constructed summary receiver operating characteristic (SROC) curves using the hierarchical regression model.

Results

We found 15 relevant studies including 851 patients. Five addressed primary tumor (T), nine addressed regional lymph nodes (N) and seven addressed distant metastasis (M). The combined sensitivity estimate for FDG-PET/CT in T classification was 0.77(95% confidence interval (CI) 0.59-0.95). For N classification, combined sensitivity was 0.84 (95% CI 0.76-0.91), specificity was 0.90(95% CI 0.83-0.97), DOR was 82.4 (23.2 to 292.6) and Q*-index was 0.90. For M classification, the combined sensitivity estimate was 0.87(95% CI 0.74-1.00), specificity was 0.98 (95% CI 0.96 – 1.00), DOR was 120.9 (43.0 to 340.0) and Q*-index was 0.89.

Conclusion

FDG-PET/CT showed good accuracy in N and M but not T classification for newly diagnosed NPC. FDG-PET/CT, together with Magnetic resonance imaging (MRI) of the nasopharynx, should be part of the routine staging investigations.

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