Diagnostic efficacy of computed tomography and magnetic resonance imaging in detection of cervical lymph node metastasis among patients with oral cancer in India – Systematic review and meta-analysis

Background: Oral cancer in India accounts for two-third of global incidence. Ninety percent are squamous cell type that are prone to neck lymph node metastasis. Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods used in our clinical practice for treatment planning, determine the prognosis and after treatment follow-up. Aim: The aim of this study was to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis among oral cancer patients in India using systematic review and meta-analysis. Methods: Literature search was conducted by manual search as well as in academic databases such as Scopus, PubMed, Medline, ScienceDirect, and Google Scholar from 2000 to 2021. Based on inclusion and exclusion criteria's, studies were analysed and tabulated. Qualitative assessment of included studies was done with QUADAS-2 which assessed the risk of bias. Further meta-analysis was done to know the efficacy of CT and MRI in identifying lymph node metastases. Results: A total of 14 studies including 516 participants were involved. With overall pooled sensitivity and specificity in the meta-analysis, CT showed a sensitivity of 92% and specificity of 70% and MRI had a sensitivity of 75% and specificity of 91%, which was identified in ROC curve in detecting the cervical lymph node metastasis. The diagnostic criteria for MRI and CT in identifying cervical lymph node metastasis includes key features like increases in size, round shape, structural changes, and extra nodal extension. Conclusion: CT has a good sensitivity and MRI has a good specificity, which are essential for selective neck dissection.