Meta-Analysis Comparing the Diagnostic Accuracy of X-Rays and CT in Detecting Ingested Foreign Bodies in the Neck

This meta-analysis aims to compare the diagnostic efficacy of X-ray and CT in detecting oesophageal foreign bodies and evaluate if this data supports the current radiological and gastroenterology guidelines on managing foreign bodies in the oesophagus.

A literature search was conducted and 6 studies comprising 329 X-rays and 337 CTs were selected for this meta-analysis. Raw sensitivity and specificity data for X-ray and CT sensitivity and specificity were extracted by 2 independent reviewers and pooled together. A 'mada' and 'meta' package in R (1-3) was used to analyse the sensitivity and specificity of the data. Further subgroup analysis was performed.

X-rays demonstrate a pooled sensitivity of 51.2% and specificity of 99.5%, while CT exhibits superior sensitivity (99.8%) and specificity (100%) without significant heterogeneity. CT demonstrated a statistically significant superiority in detecting ingested foreign bodies. CT thus has a better detection rate but imparts higher radiation doses to the patient.

CT is a far superior imaging modality for detecting ingested foreign bodies than X-rays, particularly for radiolucent objects. The superior diagnostic capability of CT scans should be weighed against the cost of resources and the increased radiation dose. These results support X-rays as the first-line test for radiopaque foreign bodies. It supports CT as the first-line imaging modality for radiolucent FB and the second line when initial X-rays are negative, but there remains a high clinical suspicion of a stuck foreign body.