The Diagnostic Value of SUVmax in Predicting Lymphovascular Space Invasion in Patients with Endometrial Cancer: A Systematic Review and Meta-Analysis

Abstract

Objectives: To evaluate the ability of the maximum standardized uptake value (SUVmax) to predict the lymphovascular space invasion (LVSI) status in endometrial cancer (EC).

Method: PubMed/MEDLINE, Web of Science, Embase, and the Cochrane Library were systematically searched for all original studies evaluating the diagnostic efficacy of LVSI using PET/CT or PET/MR. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). A bivariate random effects model was used to acquire pooled sensitivity, specificity, heterogeneity, and the area under the summary receiver operating characteristic curve (AUROC). Meta-regression and sensitivity analysis were performed to identify sources of heterogeneity.

Results: A total of 6 studies (257 patients) were included. Most studies had a low risk of bias, and all studies had minimal applicability concerns. The summary AUROC values, pooled sensitivity and specificity of SUVmax in detecting LVSI in EC were 0.77, 62% and 83%, respectively. One study may have contributed to the unstable results of this study according to the sensitivity analysis.

Conclusion: Our study showed that SUVmax has moderate accuracy in noninvasively predicting LVSI in EC. More original studies with large samples are needed in the future to evaluate the role of SUVmax in differentiating LVSI.

Advances in knowledge: LVSI is closely related to the prognosis of EC, and it can only be obtained by surgical pathology. SUVmax has moderate diagnostic performance in preoperatively predicting LVSI in EC. Future studies with large samples are needed to confirm the clinical value of SUVmax in the preoperative prediction of LVSI.

Keywords: LVSI; diagnostic accuracy; endometrial cancer; meta-analysis.