1.
Limited additional value of cervical ultrasonography over a negative 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with esophageal cancer: a systematic review and meta-analysis.
Goense, L, Meziani, J, van Rossum, PSN, Wessels, FJ, Meijer, GJ, Lam, MGEH, van Hillegersberg, R, Ruurda, JP
Nuclear medicine communications. 2018;(7):645-651
Abstract
OBJECTIVE To assess the additional value of cervical ultrasonography as supplement to a negative fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) for detecting cervical lymph node metastases during the initial staging of patients with esophageal cancer. METHODS PubMed/Medline, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies describing the accuracy of cervical ultrasonography and integrated F-FDG PET/CT or standalone F-FDG PET and CT for detecting cervical lymph node metastases in patients with esophageal cancer. The reference standard consisted of cytopathology and/or clinical follow-up. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of the included studies. A random effects model was used to meta-analyze the additional diagnostic value of cervical ultrasonography. RESULTS Four diagnostic studies were eligible and included for meta-analysis, comprising 567 patients with esophageal cancer who underwent diagnostic workup before treatment. The quality of the included studies was considered reasonable; there were few concerns regarding risk of bias and applicability. In three of the four studies, cervical ultrasonography did not detect cervical lymph node metastases in addition to a negative finding on F-FDG PET/CT or standalone F-FDG PET and CT. In one study, cervical ultrasonography detected additional cervical lymph node metastases in 4% (3/74) of patients over standalone F-FDG PET and CT. Pooled estimate of the additional value of cervical ultrasonography was 1% (95% confidence interval: 0-5%). CONCLUSION Cervical ultrasonography has very limited additional diagnostic value as supplement to a negative F-FDG PET/CT in the detection of cervical lymph node metastases during the initial staging of patients with esophageal cancer.
2.
Transvaginal Ultrasound for the Diagnosis of Adenomyosis: Systematic Review and Meta-Analysis.
Andres, MP, Borrelli, GM, Ribeiro, J, Baracat, EC, AbrĂ£o, MS, Kho, RM
Journal of minimally invasive gynecology. 2018;(2):257-264
Abstract
Adenomyosis is characterized by the presence of ectopic foci of endometrial glandular tissue and/or stroma within the myometrium. The diagnosis of adenomyosis is traditionally made through histologic evaluation of the postsurgical specimen. More recently, imaging with transvaginal ultrasound (TVUS) has been used for the preoperative diagnosis of adenomyosis. As yet, there is no consensus regarding the best imaging feature or combination thereof for the nonsurgical diagnosis of adenomyosis. This study systematically evaluated the literature in the last 10 years to determine the accuracy of 2-dimensional (2D) TVUS, different imaging features, enhancing methods such as 3-dimensional (3D) TVUS, elastography and color Doppler in the nonsurgical diagnosis of adenomyosis. A total of 8 studies were included. Pooled sensitivity and specificity for 2D TVUS for the diagnosis of adenomyosis for all combined imaging characteristics was 83.8% and 63.9%, respectively. Pooled sensitivity for 355 total patients with use of imaging feature of heterogeneous myometrium with 2D TVUS was highest (86.0%), and pooled specificity for 283 total patients with use of globular uterus was highest (78.1%). After including the "question mark" sign with other TVUS features, higher sensitivity and specificity, of 92% and 88%, respectively, were noted. For 3D TVUS, pooled sensitivity and specificity for all combined imaging characteristics was 88.9% and 56.0%, respectively. Poor definition of junctional zone showed the highest pooled sensitivity (86%) and the highest pooled specificity (56.0%) for the diagnosis of adenomyosis with 3D TVUS. There was no improvement in overall accuracy in 3D TVUS compared with 2D TVUS. Preliminary results of TVUS with color Doppler showed a high sensitivity and specificity for the differentiation between adenomyosis and myomas (95.6% and 93.4%, respectively). Also, TVUS elastography in 1 study showed an improvement in specificity (82.9%) compared with 2D TVUS (63.9%), albeit with comparable sensitivity. Larger studies are needed to advance our understanding of the different types of adenomyosis and their clinical impact.