Diagnostic performance of MR imaging in evaluating prognostic factors in patients with cervical cancer: a meta-analysis
This study aims to determine the diagnostic performance of conventional magnetic resonance imaging (MRI) in assessing the distance between the tumor and the internal os, stromal infiltration, lymph node metastasis, and parametrial invasion in patients with cervical cancer.
A systematic English-language literature search of conventional MRI in the evaluation of human cervical cancer was performed in the PubMed, Cochrane Library, Embase, and Web of Science databases from 1995 to 2018. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratios (PLR and NLR) of all studies were calculated. The results were then plotted in a hierarchical summary receiver operating characteristic (HSROC) plot, and meta-regression and subgroup analyses of the parametrial invasion were also performed.
The pooled sensitivity, specificity, DOR, PLR, and NLR were 86%, 97%, 167.91, 24.74, and 0.15, respectively, in evaluating the internal os involvement (6 studies, 454 patients); 87%, 91%, 73.41, 10.22, and 0.14, respectively, in evaluating the stromal infiltration (11 studies, 672 patients); 51%, 89%, 8.63, 4.72, and 0.55, respectively, in evaluating the lymph node metastasis (15 studies, 997 patients); and 75%, 92%, 34.01, 9.38, and 0.28, respectively, in evaluating the parametrial invasion (19 studies, 1748 patients). The meta-regression of the parametrial invasion showed that the application of contrast enhancement was a significant factor affected the heterogeneity (p = 0.039).
Conventional MRI can accurately evaluate the distance between the tumor and the internal os, as well as stromal infiltration, and performs well in diagnosing the parametrial invasion. However, this method exhibited a limited ability in diagnosing the lymph node metastasis.
• MRI can help clinicians to accurately assess the distance between the tumor and the internal os, stromal infiltration, and parametrial invasion in patients with uterine cervical neoplasms.
• MRI exhibits a limited ability in diagnosing the lymph node metastasis.
• Management of patients with uterine cervical neoplasms becomes more appropriate.
KeywordsMagnetic resonance imaging Cervical cancer Lymph node metastasis Parametrial invasion Meta-analysis
Area under the curve
Diagnostic odds ratio
International Federation of Gynecology and Obstetrics
Hierarchical summary receiver operating characteristic
Magnetic resonance imaging
Negative likelihood ratios
Positive likelihood ratios
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Quality Assessment of Diagnostic Accuracy Studies-2
This study has received funding from the National Natural Science Foundation of China (No. 81471628) and the Shanghai Municipal Commission of Health and Family Planning, China (No. 2013SY075 and No. ZK2015A05).
Compliance with ethical standards
The scientific guarantor of this publication is Jinwei Qiang.
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 (Ying Li) has significant statistical expertise.
Written informed consent was not required for this study due to the nature of the study, which was a meta-analysis.
Institutional Review Board approval was not required for this study due to the nature of the study, which was a meta-analysis.
• Performed at one institution
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