Diagnostic imaging modalities to detect regional nodal involvement in oral squamous cell carcinoma: a systematic review and meta-analysis

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Abstract
Objectives To determine the most effective diagnostic imaging modality including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography–computed tomography (PET/CT), and ultrasound (US) for the identification of regional lymph node involvement in patients with oral squamous cell carcinoma (OSCC). Methods A search was performed to identify qualified studies using PubMed, Scopus, and Web of Science electronic databases from January 2013 to December 2023. The outcome assessed was the diagnostic performance of different imaging techniques in the detection of cervical lymph node metastasis in OSCC, with lymph node yield in neck dissection specimens as the gold standard for validation. Summary estimates for diagnostic performance were sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs). Differences in sensitivities, specificities, and DOR were tested using a bivariate random effects model. Results Twelve observational studies including PET/CT, MRI, and CT alone or combined in OSCC patients were included in the meta-analysis. Data from a single study based on US were insufficient to assess the value of this imaging modality. The pooled estimates of sensitivity were 0.87 for PET/CT, 0.70 for MRI, and 0.66 for CT. The corresponding pooled specificities were 0.79, 0.79, and 0.81, respectively. The DOR was 24.85 for PET/CT, 8.60 for MRI, and 8.59 for CT. Conclusion PET/CT may be recommended in clinical practice for detecting cervical metastatic disease in OSCC patients as this technique showed the most favorable diagnostic performance as compared with MRI and CT.

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