title: Accuracy of (18)F-flurodeoxyglucose-positron emission tomography/computed tomography in the staging of newly diagnosed nasopharyngeal carcinoma: a systematic review and meta-analysis.
abstract: BACKGROUND
  The specific role of 18F-flurodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in staging of nasopharyngeal carcinoma (NPC) remains to be validated. A systematic review and meta-analysis were performed to assess the accuracy of staging FDG-PET/CT for newly diagnosed NPC.
  
  
  METHODS
  We searched various biomedical databases and conference proceedings for relevant studies. We determined the pooled sensitivities and specificities, diagnostic odds ratios (DOR) and constructed summary receiver operating characteristic (SROC) curves using the hierarchical regression model.
  
  
  RESULTS
  15 relevant studies including 851 patients were identified. Five addressed primary tumor (T), nine addressed regional lymph nodes (N) and seven addressed distant metastasis (M). The combined sensitivity estimate for FDG-PET/CT in T classification was 0.77 (95% confidence interval [CI] 0.59-0.95). For N classification, combined sensitivity was 0.84 (95% CI 0.76-0.91), specificity was 0.90 (95% CI 0.83-0.97), DOR was 82.4 (23.2-292.6) and Q*-index was 0.90. For M classification, the combined sensitivity estimate was 0.87 (95% CI 0.74-1.00), specificity was 0.98 (95% CI 0.96-1.00), DOR was 120.9 (43.0-340.0) and Q*-index was 0.89.
  
  
  CONCLUSIONS
  FDG-PET/CT showed good accuracy in N and M but not T classification for newly diagnosed NPC. FDG-PET/CT, together with Magnetic resonance imaging (MRI) of the nasopharynx, should be part of the routine staging investigations.
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Singapore.
authors.forename: Balamurugan A
authors.initials: BA
authors.lastname: Vellayappan
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Singapore.
authors.forename: Yu Yang
authors.initials: YY
authors.lastname: Soon
authors.affiliation: Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.affiliation: Department of Radiation Oncology, Sixth Hospital of Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Singapore.
authors.forename: Wee Yao
authors.initials: WY
authors.lastname: Koh
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Singapore.
authors.forename: Ivan Weng Keong
authors.initials: IW
authors.lastname: Tham
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore, Singapore.
authors.forename: Khai Mun
authors.initials: KM
authors.lastname: Lee
keywords: PET/CT; accuracy; meta-analysis; nasopharyngeal carcinoma; staging