J Cancer 2017; 8(7):1238-1248. doi:10.7150/jca.18361

Research Paper

Optimal Modality for Detecting Distant Metastasis in Primary Nasopharyngeal Carcinoma during Initial Staging: A Systemic Review and Meta-analysis of 1774 Patients

Cheng Xu1*, Yuan Zhang1*, Liang Peng1*, Xu Liu1, Wen-Fei Li1, Ying Sun1, Xu Zhang2, Xiao-Ping Lin2, Qing Liu3, Jun Ma1✉

1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, China;
2. Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, China;
3. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Canton, China.
* Cheng Xu, Yuan Zhang, and Liang Peng contributed equally to this work.

Abstract

Purpose: To compare the diagnostic performance of two modalities commonly used for detecting distant metastasis in primary nasopharyngeal carcinoma (NPC): 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and conventional work-ups (CWUs).

Methods: All topic-related studies were comprehensively searched and included. We determined sensitivities and specificities across studies, calculated negative and positive likelihood ratios (LR- and LR+, respectively), and constructed summary receiver operating characteristic curves. Moreover, we compared the diagnostic performance of PET/CT and CWUs by analyzing studies that reported the results of these diagnostic methods on the same patients.

Results: The pooled sensitivity and specificity were 85.7% and 98.1% for PET/CT (1474 patients), and 38.0% and 97.6% for CWUs (1329 patients). In the head-to-head comparison of PET/CT and CWUs (1029 patients), PET/CT showed a significantly higher sensitivity (83.7% vs. 40.1%, P < 0.001) and lower LR- (0.169 vs. 0.633, P < 0.001) than CWUs on a per-patient basis; no significant difference was observed in pooled specificity (97.7% vs. 97.8%, P = 0.892) or LR+ (36.416 vs. 16.845, P = 0.149). The superiority of PET/CT over CWUs was due mainly to the better diagnostic performance on bone metastasis. However, suboptimal sensitivity of PET/CT was reported in the aspect of detection of liver metastasis. Sensitivity analyses showed relatively poor sensitivity and LR- of PET/CT compared to the original analysis.

Conclusions: PET/CT was superior to CWUs in detecting distant metastasis in primary NPC. However, the efficacy of PET/CT in detecting liver metastasis still requires further optimization.

Keywords: Positron emission tomography/computed tomography, nasopharyngeal carcinoma, distant metastasis, diagnosis, meta-analysis.

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How to cite this article:
Xu C, Zhang Y, Peng L, Liu X, Li WF, Sun Y, Zhang X, Lin XP, Liu Q, Ma J. Optimal Modality for Detecting Distant Metastasis in Primary Nasopharyngeal Carcinoma during Initial Staging: A Systemic Review and Meta-analysis of 1774 Patients. J Cancer 2017; 8(7):1238-1248. doi:10.7150/jca.18361. Available from http://www.jcancer.org/v08p1238.htm