Diagnostic performance of CT in detection of metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis

  • Se Jin Cho
  • Chong Hyun Suh
  • Jung Hwan BaekEmail author
  • Sae Rom Chung
  • Young Jun Choi
  • Jeong Hyun Lee
Computed Tomography



Although ultrasound (US) is a standard modality for the assessment of cervical lymph node metastasis in patients with thyroid cancer, there is an increasing trend in the number of articles describing the use of contrast-enhanced computed tomography (CT). The purpose of this systematic review and meta-analysis was to evaluate the diagnostic performance of CT in the diagnosis of metastatic cervical lymph nodes and to identify the parameters responsible for heterogeneity in diagnostic performance.


Ovid-MEDLINE and EMBASE databases were searched up to May 22, 2018, for studies on the diagnostic performance of CT. The pooled sensitivity and specificity of all studies were calculated. In addition, subgroup analysis and meta-regression analysis were performed to evaluate factors responsible for heterogeneity.


Seventeen (6378 patients, 11,590 lymph nodes) studies were included. The pooled sensitivity was 55% (95% CI, 47–63%), and the pooled specificity was 87% (95% CI, 90–95%). Higgins I2 statistic demonstrated substantial heterogeneity in the sensitivity (I2 = 96.3%) and specificity (I2 = 93.8%). In a per-neck level subgroup analysis, the Higgins I2 statistic demonstrated reduced heterogeneity in both sensitivity and specificity. In the meta-regression analysis, variation in the CT protocols, such as contrast amount, scan phase, and reconstruction slice thickness, was a statistically significant factor causing heterogeneity.


CT demonstrated acceptable diagnostic performance in the pre- and postoperative diagnosis of metastatic cervical lymph nodes in patients with thyroid cancer. Variation in the CT protocols was a main factor causing heterogeneity among the included studies.

Key Points

The role of contrast-enhanced computed tomography (CT) needs to be reassessed.

CT demonstrated acceptable diagnostic performance in the diagnosis of metastatic cervical lymph nodes in patients with thyroid cancer in the meta-analysis.

Variation in the CT protocols was a main factor causing heterogeneity in the meta-regression analysis.


Multislice computed tomography Lymph nodes Meta-analysis Thyroid cancer Papillary thyroid cancer 



Contrast-enhanced computed tomography


Hierarchic summary receiver operating characteristic


Papillary thyroid carcinoma


Radiofrequency ablation





The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Jung Hwan Baek.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chong Hyun Suh) has significant statistical expertise (5 years of experience in a systematic review and meta-analysis).

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.


• performed at one institution

Supplementary material

330_2019_6036_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Se Jin Cho
    • 1
  • Chong Hyun Suh
    • 1
  • Jung Hwan Baek
    • 1
    Email author
  • Sae Rom Chung
    • 1
  • Young Jun Choi
    • 1
  • Jeong Hyun Lee
    • 1
  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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