Diagnostic Value of 18F-FDG PET for Evaluation of Paraaortic Nodal Metastasis in Patients with Cervical Carcinoma:

We assessed the diagnostic performance of 18F-FDG PET in detecting paraaortic lymph node (PALN) metastasis in patients with cervical cancer. Methods: Through a search of MEDLINE and EMBASE (1980 to March 2009), we performed a random-effects metaanalysis. A summary receiver-operating-character-istic curve was constructed using hierarchical regression models. To identify other sources of heterogeneity, regression metaanalysis was performed. Results: Patients (n 5 385) from 10 studies were analyzed. Although specificity of 18F-FDG PET was consistent (97%; 95 % confidence interval [CI], 93%299%), sensitivity was low and heterogeneous among the studies (34%; 95 % CI, 10%272%). Although regression metaanalysis did not identify any source to which heterogeneity could be attributed, it revealed a trend of increasing sensitivity according to an increase in the prevalence of PALN metastasis (P 5 0.001). In the 5 studies with prevalence greater than 15%, estimated sensitivity and specificity were 73 % (95 % CI, 53%287%) and 93 % (95 % CI, 86%297%), respectively. With the diagnostic performance, assuming the prevalence of 15%, the calculated false-positive and-negative rates were 35 % and 5%, respectively. Conclusion: In detecting PALN metastasis, PET performs acceptably only in populations with a relatively high probability of PALNmetastasis. Otherwise, we found no ev-idence to justify the evaluation of PALN based solely on PET in cervical cancer