Predicting extracapsular spread of head and neck cancers using different imaging techniques: a systematic review and meta-analysis

This study compared the diagnostic ability of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and positron emission tomography/CT (PET/CT) for extracapsular spread. MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Sciencepaper Online databases were searched. The mean sensitivity of CT was 0.77, specificity was 0.85, positive likelihood ratio (LR+) was 4.839, negative likelihood ratio (LR-) was 0.287, diagnostic odds ratio (DOR) was 19.239, area under the summary receiver operating characteristic curve (AUC) was 0.8615, and Q* was 0.7922. The mean sensitivity of MRI was 0.85, specificity was 0.84, LR+ was 4.615, LR- was 0.191, DOR was 60.270, AUC was 0.9454, and Q* was 0.8844. The sensitivity and specificity of PET/CT were both 0.86. The mean sensitivity of US was 0.87 and specificity was 0.75. Overall, CT had the lowest sensitivity (P = 0.0355); specificity was similar for all methods (P = 0.1159). CT and MRI had equivalent summary diagnostic efficacy (AUC and Q*) (P > 0.05). This evidence indicates that CT might have a relatively lower sensitivity when diagnosing ECS, and that CT and MRI may be similarly effective in diagnosing ECS. MRI showed positive trends in diagnosing ECS. Evidence was lacking for PET/CT and US diagnosis. More related studies are required to confirm these inconclusive results.