The accuracy of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of newly diagnosed nasopharyngeal carcinoma: A systematic review and meta-analysis.

Abstract

5553 Background: The specific role of FDG-PET/CT in pretreatment staging of nasopharyngeal carcinoma (NPC) remains to be validated. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of staging FDG-PET/CT for newly diagnosed NPC with reference to conventional staging modalities and/or clinical follow up. Methods: We searched MEDLINE, Cochrane central register of controlled trials, proceedings of ASTRO and ASCO as well as Chinese databases (Chinese National Knowledge Infrastructure and CBMdisc) from the date of inception to September 2011 for relevant studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. We determined the sensitivities and specificities across studies, pooled diagnostic odds ratios (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression model. Results: We found 15 relevant studies (of which seven were in English) including 851 patients. Of the 15 studies: 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). The combined sensitivity estimate for N classification was 0.88 (95% CI 0.86-0.90), specificity 0.85(95% CI 0.83-0.88), DOR 82.4 (23.2 to 292.6) and Q-index was 0.90. For M classification, the combined sensitivity estimate was 0.82(95% CI 0.65-0.93), specificity 0.98 (95% CI 0.96 – 0.99), DOR 120.9 (43.0 to 340.0) and Q-index was 0.89. Conclusions: FDG-PET/CT showed good accuracy in N and M but not T classification for newly diagnosed pre-treated NPC. FDG-PET/CT, together with Magnetic resonance imaging (MRI) of the nasopharynx, should be part of the routine staging investigations for NPC. Future research should evaluate the accuracy of FDG-PET/MRI fusion as a single staging modality for NPC.