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FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is increasingly used to evaluate treatment response in head and neck squamous cell carcinoma (HNSCC). This analysis assessed the diagnostic value of FDG-PET/CT in detecting nodal disease within 6 months after treatment, considering patient and disease characteristics.

Methods

A systematic review was performed using the MEDLINE and Web of Knowledge databases. The results were pooled using a bivariate random effects model of the sensitivity and specificity.

Results

Out of 22 identified studies, a meta-analysis of 20 studies (1293 patients) was performed. The pooled estimates of sensitivity, specificity and diagnostic odds ratio (with 95% CI) were 85% (76–91%), 93% (89–96%) and 76 (35–165), respectively. With the prevalence set at 10%, the positive and negative predictive values were 58% and 98%. There was significant heterogeneity between the trials (p < 0.001). HPV positive tumors were associated with lower sensitivity (75% vs 89%; p = 0.01) and specificity (87% vs 95%; p < 0.005).

Conclusion

FDG-PET/CT within 6 months after (chemo)radiotherapy in HNSCC patients is a reliable method for ruling out residual/recurrent nodal disease and obviates the need for therapeutic intervention. However, FDG-PET/CT may be less reliable in HPV positive tumors and the optimal surveillance strategy remains to be determined.

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Acknowledgements

We would like to thank the corresponding authors of the selected studies who provided additional information that contributed significantly to this meta-analysis.

This study was supported by a grant by the Flemish agency for innovation by science and technology (IWT-90867).

Funding

This study was supported by a grant by the Flemish agency for innovation by science and technology (IWT-90867).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Nils Helsen, Tim Van den Wyngaert, Laurens Carp & Sigrid Stroobants

  2. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

    Nils Helsen, Tim Van den Wyngaert, Laurens Carp & Sigrid Stroobants

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  1. Nils Helsen
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Correspondence to Nils Helsen.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

ESM 1

Forest plot of included studies with individual sensitivity and specificity with mean pooled estimates (95% CI) (GIF 73 kb)

High resolution image (EPS 5049 kb)

ESM 2

Deeks’ funnel plot to estimate small study effects. A straight line indicates the absence of any small study effects. (GIF 19 kb)

High resolution image (EPS 1321 kb)

ESM 3

(DOCX 35 kb)

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Helsen, N., Van den Wyngaert, T., Carp, L. et al. FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging 45, 1063–1071 (2018). https://doi.org/10.1007/s00259-018-3978-3

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  • DOI: https://doi.org/10.1007/s00259-018-3978-3

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