Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis.
OBJECTIVES
To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer.


METHODS
Pubmed and Embase databases were searched for studies published from 2000 to 2019 that used ultrasound (US), CT, MRI, and/or PET for evaluating various aspects of local extent and nodal metastasis in patients with newly diagnosed cervical cancer. Sensitivities and specificities from the studies were meta-analytically pooled using bivariate and hierarchical modeling.


RESULTS
Of 1311 studies identified in the search, 115 studies with 13,999 patients were included. MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71-0.88 and 0.86-0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively-performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29-0.69) but high specificity (0.88-0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site).


CONCLUSIONS
MRI is the method of choice for assessing any aspect of local extent, but where not available, US could be of value, particularly for assessing PMI. CT, MRI, and PET all have high specificity but poor sensitivity for the detection of lymph node metastases.


KEY POINTS
• Magnetic resonance imaging is the method of choice for assessing local extent. • Ultrasound may be helpful in determining parametrial invasion, especially in lower-resourced countries. • Computed tomography, magnetic resonance imaging, and positron emission tomography perform similarly for assessing lymph node metastasis, with high specificity but low sensitivity.
['Woo|Sungmin|S|http://orcid.org/0000-0001-8459-8369', 'Atun|Rifat|R|', 'Ward|Zachary J|ZJ|', 'Scott|Andrew M|AM|', 'Hricak|Hedvig|H|', 'Vargas|Hebert Alberto|HA|']
D005260:Female D019788:Fluorodeoxyglucose F18 D006801:Humans D008207:Lymphatic Metastasis D008279:Magnetic Resonance Imaging D009361:Neoplasm Invasiveness D049268:Positron-Emission Tomography D012680:Sensitivity and Specificity D014057:Tomography, X-Ray Computed D014463:Ultrasonography D002583:Uterine Cervical Neoplasms
Magnetic resonance imaging Neoplasm staging Positron-emission tomography Ultrasonography Uterine cervical neoplasms