Role of ultrasound in detection of lymph‐node metastasis in gynecological cancer: systematic review and meta‐analysis.

Objective: To assess the diagnostic performance of transvaginal sonography (TVS) for the preoperative evaluation of lymph‐node metastasis in gynecological cancer. Methods: This was a systematic review and meta‐analysis of studies published between January 1990 and May 2023 evaluating the role of ultrasound in detecting pelvic lymph‐node metastasis (index test) in gynecological cancer, using histopathological analysis as the reference standard. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Pooled sensitivity, specificity and diagnostic odds ratio were estimated. Results: The literature search identified 2638 citations. Eight studies reporting on a total of 967 women were included. The mean prevalence of pelvic lymph‐node metastasis was 24.2% (range, 14.0–65.6%). The risk of bias was low for most domains assessed. Pooled sensitivity, specificity and diagnostic odds ratio of TVS were 41% (95% CI, 26–58%), 98% (95% CI, 93–99%) and 32 (95% CI, 14–72), respectively. High heterogeneity was found between studies for both sensitivity and specificity. Conclusion: TVS showed a high pooled specificity for the detection of pelvic lymph‐node metastasis in gynecological cancer, but pooled sensitivity was low. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]