Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review

Background: In advanced epithelial ovarian cancer (EOC), the LION trial restricted lymphadenectomy indication to patients with suspect lymph nodes before and during surgery. Preoperative imaging is used to assess lymph node status, and particularly CT and PET/CT. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of preoperative CT and PET/CT to detect lymph node metastasis (LNM) in patients with EOC; Methods: Databases were searched from January 1990 to May 2019 for studies that evaluated the diagnostic accuracy of preoperative CT and PET/CT to detect LNM in patients with EOC with histology as the gold standard. Pooled diagnostic accuracy was calculated using bivariate random-effects models and hierarchical summary receiver operating curve (HSROC). This study is registered with PROSPERO number CRD42020179214; Results: A total of five studies were included in the meta-analysis: four articles concerned preoperative CT and four articles concerned preoperative PET/CT, involving 106 and 138 patients, respectively. For preoperative CT, pooled sensitivity was 0.47 95% CI [0.20–0.76], pooled specificity was 0.99 95% CI [0.75–1.00] and area under the curve (AUC) of the HSROC was 0.91 95% CI [0.88–0.93]. For preoperative PET/CT, pooled sensitivity was 0.81 95% CI [0.61–0.92], pooled specificity was 0.96 95% CI [0.91–0.99] and AUC of the HSROC was 0.97 95% CI [0.95–0.98]; Conclusions: PET/CT has a very high diagnostic accuracy, especially for specificity, to detect LNM in EOC and should be realized systematically, additionally to CT recommended to evaluate peritoneal spread, in the preoperative staging of patients with an advanced disease.

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Faculty Opinions recommendation of Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status: A Systematic Review and Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725765191.793511378 ◽

2015 ◽

Author(s):

Eduardo Calonje ◽

Jose Cardoso

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Meta Analysis ◽

Primary Melanoma ◽

Lymph Node Status ◽

Node Status ◽

Sentinel Lymph Node Status

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Is postoperative chemotherapy necessary for resected esophageal carcinoma after neoadjuvant chemoradiotherapy? A systematic review and meta-analysis

10.21203/rs.3.rs-27013/v1 ◽

2020 ◽

Author(s):

Liang Cheng ◽

Wei Gao ◽

Hao Yang ◽

Yu Zhou ◽

Yongsheng Zhao ◽

...

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Esophageal Carcinoma ◽

Meta Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Postoperative Chemotherapy ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Lymph Node Status ◽

Node Status

Abstract Background Both neoadjuvant chemoradiotherapy (NCRT) and postoperative chemotherapy (PT) are crucial treatments for esophageal carcinoma (EC). However, it is not clear whether PT is required for EC treatment after NCRT. This systematic review and meta-analysis aimed at clarifying the necessity of PT for resected EC after NCRT.Methods We searched PubMed, Embase, and The Cochrane Library databases for relevant studies published up to March 2020, that have compared PT and non-PT for resected EC after NCRT (NCRT + PT vs. NCRT). The primary outcome of this study was overall survival (OS). Hazard risk ratio (HR) and 95% confidence interval (CI) were calculated. Subgroup and sensitivity analyses were employed to explore heterogeneity, and the random effect model was used to merge the meta-analysis data, regardless of whether the heterogeneity was large or small.Results This study included seven retrospective cohorts, with more than 10720 patients. Most of the patients had esophageal adenocarcinomas. The Meta-analysis showed that NCRT followed by PT increased the patient OS (HR = 0.79, 95% CI 0.74–0.85, P < 0.001). However, further subgroup analysis showed that NCRT + PT might not improve the OS of resected EC patients with a negative lymph node status (HR = 0.82, 95% CI 0.67–1.01, P = 0.124). Further, we showed that NCRT with PT improved the survival of EC patients with a positive lymph node status who underwent resection (HR = 0.78, 95% CI 0.70–0.86, P < 0.001).Conclusion PT may improve the survival of lymph node-positive EC patients previously treated by NCRT. This conclusion may be more applicable to EAC patients treated with NCRT at the ypN + stage.

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