Diagnostic Accuracy of Contrast Enhanced Computed Tomography (CECT) in Cervical Lymph Node Metastasis of Oral Carcinoma: A Systematic Review and Meta-Analysis

Mukherjee, Sukriti; Bajoria, Atul Anand; N.C, Sangamesh; Bhuvaneshwari, S; Mishra, Silpiranjan; Singh, Dhirendra Kumar

doi:10.31557/APJCP.2024.25.8.2615

Diagnostic Accuracy of Contrast Enhanced Computed Tomography (CECT) in Cervical Lymph Node Metastasis of Oral Carcinoma: A Systematic Review and Meta-Analysis

Document Type : Systematic Review and Meta-analysis

Authors

Department of Oral Medicine and Radiology Kalinga Institute of Dental Sciences, Patia , Bhubaneswar, India.

10.31557/APJCP.2024.25.8.2615

Abstract

Objective: To compare the diagnostic accuracy of Contrast Enhanced Computed Tomography (CECT) compared to conventional imaging modalities and histopathological investigation in cervical lymph node metastasis in adults through a novel meta- analysis. Method: The review protocol is registered under PROSPERO(CRD42021225704) and performed in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis – Diagnostic Test Accuracy (PRISMA- DTA) checklist. Databases like PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2023 to identify the diagnostic potential of CECT in cervical lymph node metastasis of oral carcinoma. True-positive, false-positive, true-negative, false-negative, sensitivity, specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality assessment of diagnostic accuracy studies (QUADAS)- 2 tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the pooled sensitivity and pooled specificity. Additional analysis was performed in terms of positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and summary receiver operating characteristics (SROC) with Area Under Curve (AUC) and p<0.05 as statistically significant. Results: Six studies were included for qualitative synthesis and as well as for meta-analysis. Two studies had high risk of bias while four studies had low risk of bias. 651 patients underwent CECT and were taken for meta-analysis. The meta-analysis revealed that CECT for diagnosing cervical lymph node metastasis had a pooled sensitivity of 71%, pooled specificity of 14% with 60% Area Under Curve (AUC). +LR of 0.84, -LR of 1.36 and DOR of 0.59. Conclusion: CECT has an overall fair diagnostic ability and is a valid and reliable tool in diagnosing the target condition overcoming high reliance on master specialized capacity for their execution and understanding like other conventional imaging techniques. CECT can be concluded for secondary level of prevention for cervical node metastasis of oral carcinoma under early diagnosis and prompt treatment. However, further standardized accuracy studies are indicated to improve the overall diagnostic accuracy of CECT.

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