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Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis

  • Oncology
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Abstract

Objectives

To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer.

Methods

Pubmed and Embase databases were searched for studies published from 2000 to 2019 that used ultrasound (US), CT, MRI, and/or PET for evaluating various aspects of local extent and nodal metastasis in patients with newly diagnosed cervical cancer. Sensitivities and specificities from the studies were meta-analytically pooled using bivariate and hierarchical modeling.

Results

Of 1311 studies identified in the search, 115 studies with 13,999 patients were included. MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71–0.88 and 0.86–0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively—performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29–0.69) but high specificity (0.88–0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site).

Conclusions

MRI is the method of choice for assessing any aspect of local extent, but where not available, US could be of value, particularly for assessing PMI. CT, MRI, and PET all have high specificity but poor sensitivity for the detection of lymph node metastases.

Key Points

Magnetic resonance imaging is the method of choice for assessing local extent.

Ultrasound may be helpful in determining parametrial invasion, especially in lower-resourced countries.

Computed tomography, magnetic resonance imaging, and positron emission tomography perform similarly for assessing lymph node metastasis, with high specificity but low sensitivity.

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Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

FIGO:

International Federation of Gynecology and Obstetrics

HSROC:

Hierarchical summary receiver operating characteristic

IVIM:

Intravoxel incoherent motion

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

PICOS:

Patient, index test, comparator, outcome, and study design

PMI:

Parametrial invasion

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

US:

Ultrasound

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Acknowledgments

We thank Ada Muellner, Editor, Department of Radiology, Memorial Sloan Kettering Cancer Center, for editorial assistance.

Funding

The work of Drs. Hricak, Vargas and Woo was supported by a P30 Cancer Center Support Grant (P30 CA008748) from the National Cancer Institute to Memorial Sloan Kettering Cancer Center. Otherwise, the authors state that this work has not received any funding.

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Correspondence to Sungmin Woo.

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The scientific guarantor of this publication is Sungmin Woo (woos@mskcc.org).

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this was a systematic review and meta-analysis using published studies in the literature but not analyzing specific human subjects.

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Institutional review board approval was not required because this was a systematic review and meta-analysis using published studies in the literature but not analyzing specific human subjects.

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• retrospective

• multicenter study

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Woo, S., Atun, R., Ward, Z.J. et al. Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis. Eur Radiol 30, 5560–5577 (2020). https://doi.org/10.1007/s00330-020-06909-3

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  • DOI: https://doi.org/10.1007/s00330-020-06909-3

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