A tomografia computadorizada com contraste apresenta bom desempenho diagnóstico na detecção de metástases linfonodais ou ósseas do carcinoma espinocelular de cabeça e pescoço? Uma revisão sistemática e meta-análise

Abstract

Head and neck squamous cell carcinoma (HNSCC) is an aggressive neoplasm that represents a significant global public health challenge, where accurate diagnosis of tumor extent is crucial for staging and therapeutic success. Contrast-enhanced computed tomography (CECT) is one of the most widely used tools for assessing bone invasion and lymph node involvement; however, uncertainties remain regarding its actual accuracy compared to histopathological examination. This study conducted a systematic review and meta-analysis to evaluate the efficacy of CECT in detecting lymph node and bone metastases in patients with HNSCC. The research was conducted across PubMed/MEDLINE, Web of Science, Scopus, Embase, and ProQuest databases, following PRISMA guidelines and Cochrane Handbook recommendations. The search strategy encompassed articles published up to March 2025, with no language or publication period restrictions, aiming for a broad and representative sample. Inclusion criteria selected clinical studies involving adult patients diagnosed with squamous cell carcinoma (HNSCC) who underwent CECT for metastasis detection, with histopathological examination as the comparative gold standard. Studies lacking sufficient quantitative data or missing accuracy, sensitivity, and specificity values were excluded. Twenty-six studies were included, totaling 2,497 patients. The meta-analysis revealed an overall accuracy of 79%, with a sensitivity of 81% and a specificity of 78%. The results indicated that criteria such as central nodal necrosis and matted nodes are robust predictors of extracapsular spread. However, it was observed that CECT may overestimate bone invasion and presents limitations in detecting micrometastases. It is concluded that CECT is an adequate and strategic diagnostic modality for surgical planning, provided its results are interpreted in integration with clinical and histopathological data.