Abstract：
OBJECTIVE: Accurate staging of ovarian cancer is critical to guide optimal management pathways. North American guidelines recommend contrast-enhanced CT as the primary work-up for staging ovarian cancer. This meta-analysis aims to compare the diagnostic accuracy of contrast-enhanced CT alone to PET/CT for detecting abdominal metastases in patients with a new or suspected diagnosis of ovarian cancer.
METHODS: A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the gray literature from inception to October 2022 was performed. Studies with a minimum of 5 patients evaluating the diagnostic accuracy of contrast-enhanced CT and/or PET/CT for detecting stage 3 ovarian cancer as defined by a surgical/histopathological reference standard ± clinical follow-up were included. Study, clinical, imaging, and accuracy data for eligible studies were independently acquired by two reviewers. Primary meta-analysis was performed in studies reporting accuracy on a per-patient basis using a bivariate mixed-effects regression model. Risk of bias was evaluated using QUADAS-2.
RESULTS: From 3701 citations, 15 studies (918 patients with mean age ranging from 51 to 65 years) were included in the systematic review. Twelve studies evaluated contrast-enhanced CT (6 using a per-patient assessment and 6 using a per-region assessment) and 11 studies evaluated PET/CT (7 using a per-patient assessment and 4 using a per-region assessment). All but one reporting study used consensus reading. Respective sensitivity and specificity values on a per-patient basis were 82% (67-91%, 95% CI) and 72% (59-82%) for contrast-enhanced CT and 87% (75-94%) and 90% (82-95%) for PET/CT. There was no significant difference in sensitivities between modalities (p = 0.29), but PET/CT was significantly more specific than CT (p < 0.01). Presumed variability could not be assessed in any single category due to limited studies using per-patient assessment. Studies were almost entirely low risk for bias and applicability concerns using QUADAS-2.
CONCLUSIONS: Contrast-enhanced CT demonstrates non-inferior sensitivity compared to PET/CT, although PET/CT may still serve as an alternative and/or supplement to CT alone prior to and/or in lieu of diagnostic laparoscopy in patients with ovarian cancer. Future revisions to existing guidelines should consider these results to further refine the individualized pretherapeutic diagnostic pathway.
METHODS: A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the gray literature from inception to October 2022 was performed. Studies with a minimum of 5 patients evaluating the diagnostic accuracy of contrast-enhanced CT and/or PET/CT for detecting stage 3 ovarian cancer as defined by a surgical/histopathological reference standard ± clinical follow-up were included. Study, clinical, imaging, and accuracy data for eligible studies were independently acquired by two reviewers. Primary meta-analysis was performed in studies reporting accuracy on a per-patient basis using a bivariate mixed-effects regression model. Risk of bias was evaluated using QUADAS-2.
RESULTS: From 3701 citations, 15 studies (918 patients with mean age ranging from 51 to 65 years) were included in the systematic review. Twelve studies evaluated contrast-enhanced CT (6 using a per-patient assessment and 6 using a per-region assessment) and 11 studies evaluated PET/CT (7 using a per-patient assessment and 4 using a per-region assessment). All but one reporting study used consensus reading. Respective sensitivity and specificity values on a per-patient basis were 82% (67-91%, 95% CI) and 72% (59-82%) for contrast-enhanced CT and 87% (75-94%) and 90% (82-95%) for PET/CT. There was no significant difference in sensitivities between modalities (p = 0.29), but PET/CT was significantly more specific than CT (p < 0.01). Presumed variability could not be assessed in any single category due to limited studies using per-patient assessment. Studies were almost entirely low risk for bias and applicability concerns using QUADAS-2.
CONCLUSIONS: Contrast-enhanced CT demonstrates non-inferior sensitivity compared to PET/CT, although PET/CT may still serve as an alternative and/or supplement to CT alone prior to and/or in lieu of diagnostic laparoscopy in patients with ovarian cancer. Future revisions to existing guidelines should consider these results to further refine the individualized pretherapeutic diagnostic pathway.
摘要：
目的：卵巢癌的准确分期是指导最佳治疗途径的关键。北美指南推荐对比增强CT作为卵巢癌分期的主要检查方法。这项荟萃分析旨在比较单独对比增强CT与PET/CT的诊断准确性，以检测新诊断或疑似卵巢癌的患者的腹部转移。
方法：对MEDLINE，EMBASE,Scopus,Cochrane图书馆,并进行了从成立到2022年10月的灰色文献。包括最少5名患者的研究，评估对比增强CT和/或PET/CT的诊断准确性，以检测手术/组织病理学参考标准±临床随访所定义的3期卵巢癌。Study,临床,成像,符合条件的研究的准确性数据由两名评审员独立获取.在使用双变量混合效应回归模型报告每个患者准确性的研究中进行了主要荟萃分析。使用QUADAS-2评估偏倚风险。
结果：来自3701次引用，15项研究（918例患者，平均年龄为51至65岁）纳入系统评价。12项研究评估了对比增强CT（6项使用每个患者评估，6项使用每个区域评估），11项研究评估了PET/CT（7项使用每个患者评估，4项使用每个区域评估）。除一项报告研究外，所有报告研究均使用共识阅读。每个患者的敏感度和特异度值为82%(67-91%，95％CI）和增强CT的72％（59-82％），PET/CT的87％（75-94％）和90％（82-95％）。模态之间的敏感性没有显著差异(p=0.29)，但PET/CT的特异性明显高于CT(p<0.01)。由于使用每位患者评估的研究有限，因此无法在任何单一类别中评估推测的变异性。使用QUADAS-2的研究几乎完全是低偏倚风险和适用性问题。
结论：与PET/CT相比，对比增强CT的敏感性不差，尽管在卵巢癌患者的诊断性腹腔镜检查之前和/或代替腹腔镜检查，PET/CT仍可作为单独CT的替代和/或补充。对现有指南的未来修订应考虑这些结果，以进一步完善个性化的治疗前诊断途径。
方法：对MEDLINE，EMBASE,Scopus,Cochrane图书馆,并进行了从成立到2022年10月的灰色文献。包括最少5名患者的研究，评估对比增强CT和/或PET/CT的诊断准确性，以检测手术/组织病理学参考标准±临床随访所定义的3期卵巢癌。Study,临床,成像,符合条件的研究的准确性数据由两名评审员独立获取.在使用双变量混合效应回归模型报告每个患者准确性的研究中进行了主要荟萃分析。使用QUADAS-2评估偏倚风险。
结果：来自3701次引用，15项研究（918例患者，平均年龄为51至65岁）纳入系统评价。12项研究评估了对比增强CT（6项使用每个患者评估，6项使用每个区域评估），11项研究评估了PET/CT（7项使用每个患者评估，4项使用每个区域评估）。除一项报告研究外，所有报告研究均使用共识阅读。每个患者的敏感度和特异度值为82%(67-91%，95％CI）和增强CT的72％（59-82％），PET/CT的87％（75-94％）和90％（82-95％）。模态之间的敏感性没有显著差异(p=0.29)，但PET/CT的特异性明显高于CT(p<0.01)。由于使用每位患者评估的研究有限，因此无法在任何单一类别中评估推测的变异性。使用QUADAS-2的研究几乎完全是低偏倚风险和适用性问题。
结论：与PET/CT相比，对比增强CT的敏感性不差，尽管在卵巢癌患者的诊断性腹腔镜检查之前和/或代替腹腔镜检查，PET/CT仍可作为单独CT的替代和/或补充。对现有指南的未来修订应考虑这些结果，以进一步完善个性化的治疗前诊断途径。
