Article Figures & Data
Figures
- FIGURE 1.
(A) Flowchart illustrating criteria for selecting studies to be included in analysis. (B) Summary charts demonstrating results for assessment of risk of bias and applicability concerns for included studies using QUADAS-2 criteria. End results for each domain are expressed as percentages, whereas number of studies is indicated within bars.
- FIGURE 2.
Summary receiver-operating-characteristic (SROC) curves for PET/MRI in evaluation of primary tumor (A), nodal regions (B), and locoregional HNSCC (C). SENS = sensitivity; SPEC = specificity; AUC = area under curve.
- FIGURE 3.
Deeks funnel plot showing relatively evenly distributed studies for locoregional HNSCC evaluated by PET/MRI. OR = odds ratio.
Tables
Reference Country of study Patients (n) Age (y) Cancer subtype Park et al. (23) South Korea 73 (48 M, 25 F) 59 Various Flygare et al. (15) Sweden 40 (32 M, 8 F) 64 Oropharyngeal Platzek et al. (16) Germany 38 (30 M, 8 F) 63 Various Cebeci et al. (24) Turkey 44 (37 M, 7 F) 66 Various Partovi et al. (22) United States 14 (13 M, 1 F) 55 Various Loeffelbein et al. (25) Germany 33 (21 M, 12 F) 57 Various Piao et al. (26) China 60 (45 M, 15 F) 51 Nasopharyngeal Kubiessa et al. (17) Germany 17 (13 M, 4 F) 60 Various Kanda et al. (27) Japan 30 (24 M, 6 F) 67 Various Murtojärvi et al. (28) Finland 52 (36 M, 16 F) 64 Various Becker et al. (18) Switzerland 74 (50 M, 24 F) 62 Various Hayashi et al. (19) Japan 11 (8 M, 3 F) 73 Oropharyngeal Chan et al. (20) Taiwan 113 (86 M, 27 F) 51 Nasopharyngeal Huang et al. (21) Taiwan 27 (26 M, 1 F) 55 Buccal SCC Schaarschmidt et al. (29) Germany 12 (12 M) 60 Various SCC = squamous cell carcinoma.
- TABLE 2.
Summary of Pooled Sensitivity and Specificity, Positive Likelihood Ratio, Negative Likelihood Ratio, Diagnostic Odds Ratio, and Study Heterogeneity
Site of analysis* Pooled sensitivity P I2 (%) Pooled specificity P I2 (%) PLR NLR DOR Primary tumor 93%
(95% CI, 87%–97%)0.44 0 95%
(95% CI, 86%–99%)0.09 57.88 23.1%
(95% CI, 6.1%–87.2%)0.07%
(95% CI, 0.04%–0.14%)331%
(95% CI, 64%–1,696%)Nodal 89%
(95% CI, 69%–97%)0.00 98 98%
(95% CI, 95%–99%)0.01 79 39.1%
(95% CI, 17.6%–86.8%)0.11%
(95% CI, 0.03%–0.36%)358%
(95% CI, 58%–2,223%)Locoregional 93%
(95% CI, 85%–97%)0.00 97 96%
(95% CI, 92%–98%)0.00 78 22.3%
(95% CI, 11.4%–43.8%)0.07%
(95% CI, 0.03%–0.17%)315%
(95% CI, 90%–1,100%)↵* Primary tumor is per patient; nodal is per lesion; locoregional is overall.
PLR = positive likelihood ratio; NLR = negative likelihood ratio; DOR = diagnostic odds ratio.
- TABLE 3.
Results of Metaregression Analysis of PET/MRI for Diagnosis of Locoregional HNSCC
Diagnostic indicators Covariate Category estimate Number of studies Sensitivity P Specificity P I2 (%) Study subjects One HNSCC subtype 2 100%
(95% CI, 99%–100%)0.00 98%
(95% CI, 95%–100%)0.68 81 Various HNSCC* subtype 10 88%
(95% CI, 81%–95%)95%
(95% CI, 92%–98%)Study design Prospective 5 94%
(95% CI, 87%–100%)0.60 95%
(95% CI, 91%–100%)0.26 0 Retrospective 7 94%
(95% CI, 83%–100%)96%
(95% CI, 93%–100%)MRI fusion Simultaneous 9 92%
(95% CI, 85%–99%)0.27 96%
(95% CI, 93%–99%)0.53 0 Retrospective 3 96%
(95% CI, 89%–100%)94%
(95% CI, 85%–100%)MRI acquisition With DWI 3 82%
(95% CI, 61%–100%)0.08 93%
(95% CI, 85%–100%)0.03 33 Without DWI 9 95%
(95% CI, 91%–100%)97%
(95% CI, 94%–99%)Reference standard Pathologic 5 90%
(95% CI, 78%–100%)0.55 89%
(95% CI, 80%–98%)0.92 67 Clinical and pathologic 7 95%
(95% CI, 89%–100%)98%
(95% CI, 96%–99%)QUADAS-2 risk Presence 5 97%
(95% CI, 92%–100%)0.06 96%
(95% CI, 91%–100%)0.26 16 Absence 7 89%
(95% CI, 79–99)96%
(95% CI, 93%–99%)Publication year 4.87 0.69 0.96 59 ↵* Various HNSCC refers to studies evaluating PET/MRI in patients with single primary HNSCC, regardless of its anatomic origin (more than one anatomic origin). Studies evaluating PET/MRI in patients with single primary HNSCC of similar anatomic origin, such as nasopharyngeal HNSCC, are referred to as one HNSCC subtype.
Diagnostic indicators Domain* Modality Number of studies Sensitivity P Specificity P I2 (%) Locoregional HNSCC PET/MRI 5 95% (95% CI, 90%–100%) 0.15 97% (95% CI, 94%–100%) 0.25 33 PET/CT 86% (95% CI, 74%–99%) 94% (95% CI, 88%–100%) Locoregional HNSCC PET/MRI 4 93% (95% CI, 86%–100%) 0.11 98% (95% CI, 95%–100%) 0.85 26 MRI 82% (95% CI, 64%–99%) 98% (95% CI, 95%–100%) Nodal HNSCC PET/MRI 3 95% (95% CI, 89%–100%) 0.16 99% (95% CI, 97%–100%) 0.31 33 MRI 86% (95% CI, 66%–100%) 99% (95% CI, 98%–100%) Nodal HNSCC PET/MRI 2 98% (95% CI, 92%–100%) 0.06 99% (95% CI, 99%–100%) 0.03 49 PET/CT 87% (95% CI, 68%–100%) 97% (95% CI, 96%–99%) ↵* Per lesion.
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