2017 Section 7 Green Book

Cheung et al

Citations identified using search strategy (n = 3411)

Abstracts considered relevant and evaluated (n = 312)

Abstracts rejected (n = 162):

• review articles (n = 37) • conference proceedings (n = 30) • letters to editor (n = 3) • articles could not be obtained (n = 6)

• lacked results of interest (eg initial staging of disease rather evaluation of recurrent disease) (n = 86)

Full-text articles retrieved and assessed for eligibility (n = 150)

Articles rejected (n = 123): • histological type not specified or included non- SCCs (n = 51) • dual head gamma cameras in coincidence mode used for image capture, (n = 5) • patients receiving surgery alone without radiotherapy or chemotherapy (n = 29) • insufficient diagnostic accuracy data provided for extraction (n = 9) • not prospective in design (n = 29)

Studies included in systematic review and meta-analysis (n = 27)

Figure 1. Literature flow diagram.

85.4%-90.8%), and 22.84 (95% CI: 9.42-55.38; Figure 4 ), with no correlation between sensitivity and 1-specificy (Spearman correlation coefficient –0.359, P = .189). The area under the SROC curve was 0.86 (standard error 0.04) with a Q * index of 0.80 (standard error 0.03; Figure 5 ). Distant metastases. For PET imaging for the detection of distant metastases at recurrence, there were 3 studies involving 182 patients. The sensitivity and specificity ranged from 69.2% to 100.0% and from 92.2% to 97.4%, respectively. The pooled sensitivity, specificity, PPV, NPV, and DOR were 84.6% (95% CI: 65.1%-95.6%), 94.9% (95% CI: 90.1%-97.8%), 84.6% (95% CI: 65.1%- 95.6%), 94.9% (95% CI: 90.1%-97.8%), and 81.47 (95% CI: 21.6-307.31; Figure 6 ). The Spearman correlation coefficient between logit of sensitivity and logit of 1-spe- cificity was 0.5 ( P = .67), suggesting an absence of threshold effect. The area under the curve was 0.978 (standard error 0.02), with a Q * index of 0.93 (standard error 0.04). Multiple sites combined. Some studies reported on the detec- tion of residual/recurrent disease at all sites combined (ie, local, nodal, and distant residual/recurrences considered together). This included 9 studies with a total of 662 patients, of which 4 studies reported on data for local, nodal, and/or distant recurrent disease separately as well as together. For the detection of recurrent or residual disease at any site, the sensitivity ranged from 53.8% to 100%, while the specificity ranged from 47.7% to 95.5%. The pooled sensitivity, specificity, PPV, NPV, and DOR were 81.6% (95% CI: 75.1%-87%), 86.3% (95% CI: 82.9%-89.3%), 81.6% (95% CI: 75.0%-87.0%), and 33.60 (95% CI: 16.16-

regardless of the index test result (item 6). Only 6 stud- ies 15,20,24,26,33,36 made it clear whether or not clinical informa- tion was available at the time of image interpretation (item 12). A graphical summary of the QUADAS assessment is pro- vided (Supplementary Appendix 3 at www.otojournal.org/ supplemental).

Diagnostic Accuracy of PET and PET/CT

Primary site. For PET imaging of the primary site, there were 18 studies with a total of 854 patients. The sensitivity and specificity of FDG-PET or FDG-PET/CT in detecting local residual disease or recurrences ranged from 50.0% to 100.0% and from 31.8% to 100.0%, respectively. The Spearman correlation coefficient between the logit of sen- sitivity and logit of 1-specificity was 0.298 ( P = .230), which suggested that a threshold effect was not present. The pooled sensitivity, specificity, PPV, NPV, and DOR were 86.2% (95% CI: 79.8%-91.1%), 82.3% (95% CI: 79.3%-85.1%), 52.7% (95% CI: 46.4%-58.9%), 96.3% (95% CI: 94.4%-97.7%), and 32.93 (95% CI: 19.17-56.56), respectively ( Figure 2 ). The area under the SROC curve was 0.91 (standard error 0.02) with a Q * index of 0.85 (standard error 0.02), suggesting good diagnostic accuracy ( Figure 3 ). Neck nodes. For PET imaging of residual disease or recur- rences in neck nodes, there were 15 studies involving 725 patients. The sensitivity ranged from 45.5% to 100.0%, while the specificity ranged from 53.3% to 100.0%. The pooled sensitivity, specificity, PPV, NPV, and DOR were 72.3% (95% CI: 63.1%-80.4%), 88.3% (95% CI: 85.4%- 90.8%), 72.3% (95% CI: 63.1%-80.4%), 88.3% (95% CI:

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