JNCI: CE MR for primary tumor improves lymph node assessment
When added to MRI, gadolinium-based contrast agents were found to substantially enhance the malignancy criteria for primary tumor visualization, as well as increase the accuracy in the detection of lymph node metastases, according to a meta-analysis published in the February edition of the Journal of the National Cancer Institute.
Wenche M. Klerkx, PhD, of the department of gynecology and obstetrics at the University Medical Centre Utrecht in the Netherlands, and colleagues conducted a systematic review and meta-analysis of 32 studies completed over the past decade that evaluated the diagnostic accuracy of gadolinium contrast-enhanced (CE) MRI in the evaluation of lymphatic metastases compared with histopathologic examination as the reference test. To date, gadolinium-enhanced MRI is primarily used to visualize primary tumors and highlight tumor vascularity, wrote the researchers.
Utilizing MEDLINE, Cochrane, CANCERLIT, and EMBASE databases for studies published in English or German from Jan. 1, 1988, to Jan. 1, 2008, the authors studied three subgroups of research, including the studies that used a single malignancy criterion and those that used multiple malignancy criteria with or without contrast highlighting.
Klerkx and colleagues determined that that overall accuracy of gadolinium-enhanced MRI for the detection of nodal metastases was moderate. "Gadolinium enhancement by itself does not have the diagnostic accuracy to replace histopathologic examination of lymph nodes; however, it can help identify suspicious lymph nodes that should be surgically collected for histopathologic exam," they wrote.
The levels of sensitivity and specificity in studies that utilized a single malignancy criterion with contrast enhancement were found to remain unchanged, as did the studies that utilized multiple malignancy criteria without contrast enhancement, according to the authors.
However, the authors said that sensitivity increased for the studies that incorporated contrast enhancement in their multiple malignancy criteria.
Klerkx and colleagues concluded that the accuracy of gadolinium-enhanced MRI for the detection of nodal metastases was moderate, adding that study limitations may have produced these results.
“In a diagnostic setting, there are many explanations other than publication bias for small-study effects," wrote the authors. “The borderline statistical significance should be interpreted with caution.”
Researchers also wrote that incorporating contrast enhancement in the malignancy criteria improves the accuracy of MRI.
“The results of this meta-analysis suggest that contrast highlighting of lymph nodes should be included as a malignancy criterion when gadolinium contrast agent is used for primary tumor visualization, said the authors. “We further advocate the use of uniform malignancy criteria, including contrast enhancement, for standardization of future evaluations."
Wenche M. Klerkx, PhD, of the department of gynecology and obstetrics at the University Medical Centre Utrecht in the Netherlands, and colleagues conducted a systematic review and meta-analysis of 32 studies completed over the past decade that evaluated the diagnostic accuracy of gadolinium contrast-enhanced (CE) MRI in the evaluation of lymphatic metastases compared with histopathologic examination as the reference test. To date, gadolinium-enhanced MRI is primarily used to visualize primary tumors and highlight tumor vascularity, wrote the researchers.
Utilizing MEDLINE, Cochrane, CANCERLIT, and EMBASE databases for studies published in English or German from Jan. 1, 1988, to Jan. 1, 2008, the authors studied three subgroups of research, including the studies that used a single malignancy criterion and those that used multiple malignancy criteria with or without contrast highlighting.
Klerkx and colleagues determined that that overall accuracy of gadolinium-enhanced MRI for the detection of nodal metastases was moderate. "Gadolinium enhancement by itself does not have the diagnostic accuracy to replace histopathologic examination of lymph nodes; however, it can help identify suspicious lymph nodes that should be surgically collected for histopathologic exam," they wrote.
The levels of sensitivity and specificity in studies that utilized a single malignancy criterion with contrast enhancement were found to remain unchanged, as did the studies that utilized multiple malignancy criteria without contrast enhancement, according to the authors.
However, the authors said that sensitivity increased for the studies that incorporated contrast enhancement in their multiple malignancy criteria.
Klerkx and colleagues concluded that the accuracy of gadolinium-enhanced MRI for the detection of nodal metastases was moderate, adding that study limitations may have produced these results.
“In a diagnostic setting, there are many explanations other than publication bias for small-study effects," wrote the authors. “The borderline statistical significance should be interpreted with caution.”
Researchers also wrote that incorporating contrast enhancement in the malignancy criteria improves the accuracy of MRI.
“The results of this meta-analysis suggest that contrast highlighting of lymph nodes should be included as a malignancy criterion when gadolinium contrast agent is used for primary tumor visualization, said the authors. “We further advocate the use of uniform malignancy criteria, including contrast enhancement, for standardization of future evaluations."