title: 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: a systematic review and meta-analysis.
abstract: 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography-scan (PET/CT) is used increasingly for detection of cancer. Precise diagnostic assessment of tumour extension in head and neck squamous cell carcinoma (HNSCC) is of critical importance for ensuring that patients receive proper treatment. Preliminary studies have shown divergent results of PET/CT in diagnosis and staging of HNSCC. The aims of this study were (1) to systematically review and meta-analyse published data about the diagnostic accuracy of PET/CT for diagnosing patients with HNSCC and (2) to compare the diagnostic accuracy of PET/CT with that of standard conventional imaging (SCI).
  
  
  METHODS
  A systematic literature search in the PubMed, Embase and Cochrane databases on publications of PET/CT diagnostics of HNSCC from January 2005 to July 2013 was carried out. All retrieved studies were reviewed and qualitatively analysed. Along with the calculated pooled sensitivity and specificity of PET/CT and SCI, bubble- and summary receiver operating characteristics (SROC) plots were created.
  
  
  RESULTS
  Two meta-analyses of diagnostic accuracy were conducted. The first, on PET/CT, included 987 patients distributed across nine studies. The second, on SCI, included 517 patients participating in a total of six studies among those comparing PET/CT to SCI. The meta-analyses showed a pooled sensitivity of 89.3% (95% confidence interval [95% CI]: 83.4-93.2%) and specificity of 89.5% (95% CI: 82.9-93.7%) for PET/CT and correspondingly, a pooled sensitivity and specificity of 71.6% (95% CI: 44.3-88.9%) and 78.0% (95%CI: 30.2-96.7%) for SCI. A graphical comparison to SCI showed a clear difference in favour of PET/CT.
  
  
  CONCLUSIONS
  PET/CT is highly accurate in diagnosing patients suffering from HNSCC.
authors.affiliation: Department of ENT Head & Neck Surgery, Odense University Hospital, DK-5000 Odense C, Denmark. Electronic address: max.rohde@rsyd.dk.
authors.forename: Max
authors.initials: M
authors.lastname: Rohde
authors.affiliation: Section of LEAN & Innovation, Department for Operational Optimization and IT, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Anne-Kirstine
authors.initials: AK
authors.lastname: Dyrvig
authors.affiliation: Department of Oncology, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Johansen
authors.affiliation: Department of Plastic Surgery, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Jens A
authors.initials: JA
authors.lastname: Sørensen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Nielsen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
authors.affiliation: Department of ENT Head & Neck Surgery, Odense University Hospital, DK-5000 Odense C, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Biopsy; CT; HNSCC; MRI; Meta-analysis; PET/CT