title: 99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis.
abstract: We aimed to compare SPECT/CT and lymphoscintigraphy on overall and bilateral sentinel lymph node (SLN) detection in cervical cancer patients.
  
  
  METHODS
  A systematic search was performed on August 1, 2014, in PubMed, Embase, Scopus, and the Cochrane library. The syntax was based on synonyms of the terms cervical cancer, SPECT/CT, and lymphoscintigraphy. Retrieved articles were screened on their title/abstract and considered eligible when an SLN procedure was performed using both imaging modalities and if detection results were reported. Two independent reviewers assessed all included studies on methodologic quality using QUADAS-2. Studies were pooled on their odds ratios (ORs) with a random-effects model.
  
  
  RESULTS
  The search yielded 962 unique articles, of which 8 were ultimately included. The studies were recent retrospective or prospective cohort studies of limited size (n = 7-51) but sufficient methodologic quality. The median overall detection (≥1 SLN in a patient) was 98.6% for SPECT/CT (range, 92.2%-100.0%) and 85.3% for lymphoscintigraphy (range, 70.0%-100.0%). This corresponded to a pooled overall SLN detection OR of 2.5 (95% CI, 1.2-5.3) in favor of SPECT/CT. The reported median bilateral detection (≥1 SLN in each hemipelvis) was 69.0% for SPECT/CT (range, 62.7%-79.3%) and 66.7% for lymphoscintigraphy (range, 56.9%-75.8%), yielding a pooled OR of 1.2 (95% CI, 0.7-2.1). No significant difference in the number of visualized SLNs was observed at a pooled ratio of 1.2 (95% CI, 0.9-1.6).
  
  
  CONCLUSIONS
  In cervical cancer patients, preoperative SLN imaging with SPECT/CT results in superior overall SLN detection in comparison with planar lymphoscintigraphy.
authors: Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; and j.hoogendam@umcutrecht.nl.
authors: Jacob P
authors: JP
authors: Hoogendam
authors: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Wouter B
authors: WB
authors: Veldhuis
authors: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Monique G G
authors: MG
authors: Hobbelink
authors: Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; and.
authors: René H M
authors: RH
authors: Verheijen
authors: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Maurice A A J
authors: MA
authors: van den Bosch
authors: Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; and.
authors: Ronald P
authors: RP
authors: Zweemer
mesh_terms: D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods*; D057234:Preoperative Period; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery
keywords: SPECT-CT; cervical cancer; lymphoscintigraphy; meta-analysis; sentinel lymph node