Value of Magnetic Resonance Imaging for Nodal Staging in Patients with Head and Neck Squamous Cell Carcinoma: A Meta-analysis

Abstract

To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting lymph node metastases in patients with head and neck squamous cell carcinoma (HNSCC). MEDLINE, EMBASE, the CBM disc databases, and other databases were searched for relevant original articles published between January 1990 and January 2011. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic, and to calculate positive and negative likelihood ratios (LR+ and LR-). We also compared the performance of MRI with other diagnostic methods (positron emission tomography, computed tomography, and ultrasound) by analyzing studies that had also used these diagnostic methods on the same patients. Across 16 studies, there was no evidence of publication bias (P = .15). Sensitivity and specificity of MRI for cervical lymph node status in patients with HNSCC across all studies were 76% (95% CI: 70%-82%) and 86% (95% CI: 73%-93%), respectively. Overall, Positive likelihood ratios was 5.47 (95% CI: 2.69-11.11) and positive negative likelihood ratios was 0.28 (95% CI: 0.21-0.36), respectively. The comparison of MRI performance with that of other diagnostic tools (positron emission tomography, computed tomography, and ultrasound) suggested no major differences against any of these methods. The Subgroup by using diffusion-weighted imaging had higher pooled sensitivity (0.86, 95% CI 0.78-0.92) than the subgroup without diffusion-weighted imaging. MRI has good diagnostic performance in the overall pretreatment evaluation of node staging with HNSCC. A limited number of small studies suggest DWI is superior to conventional imaging for nodal staging of HNSCC.