Magnetic resonance imaging for N staging in non-small cell lung cancer: A systematic review and meta-analysis.
BACKGROUND
Lymph node staging in non-small cell lung cancer (NSCLC) is essential for deciding appropriate treatment. This study systematically reviews the literature regarding the diagnostic performance of magnetic resonance imaging (MRI) in lymph node staging of patients with NSCLC, and determines its pooled sensitivity and specificity.


METHODS
PubMed and Embase databases and the Cochrane library were used to search for relevant studies. Two reviewers independently identified the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed.


RESULTS
Nine studies were included. These studies had moderate to good methodological quality. Pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnosis odds ratio (DOR) for per-patient based analyses (7 studies) were 74%, 90%, 7.5, 0.26, and 36.7, respectively, and those for per-lymph node based analyses (5 studies) were 77%, 98%, 42.24, 0.21, and 212.35, respectively. For meta-analyses of quantitative short time inversion recovery imaging (STIR) and diffusion-weighted imaging (DWI), pooled sensitivity and specificity were 84% and 91%, and 69% and 93%, respectively. Pooled LR+ and pooled LR- were 8.44 and 0.18, and 8.36 and 0.36, respectively. The DOR was 56.29 and 27.2 respectively.


CONCLUSIONS
MRI showed high specificity in the lymph node staging of NSCLC. Quantitative STIR has greater DOR than quantitative DWI. Large, direct, and prospective studies are needed to compare the diagnostic power of STIR versus DWI; consistent diagnostic criteria should be established.
Department of Radiation Oncology, Shandong Cancer Hospital, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences Jinan, Shandong Province, China.
Yuanyuan
Y
Zhang
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University Jinan, Shandong Province, China.
Qin
Q
Qin
Department of Radiation Oncology, Shandong Cancer Hospital, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences Jinan, Shandong Province, China ; Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University Jinan, Shandong Province, China.
Baosheng
B
Li
Department of Radiation Oncology, Shandong Cancer Hospital, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences Jinan, Shandong Province, China.
Juan
J
Wang
Department of Radiology, Hohhot First Hospital Hohhot, Inner Mongolia, China.
Kun
K
Zhang
Lymph node staging; magnetic resonance imaging; meta-analysis; non-small cell lung cancer; systematic review