Is Nutritional Ultrasound as Useful and Accurate as Computed Tomography to Assess Sarcopenia in Cancer Patients? A Systematic Review.

Abstract

<h4>Background</h4>Sarcopenia assessment provides significant prognostic information that outperforms body mass index and will help to guide interventions to optimize survival outcomes in cancer patients. Computed tomography (CT) is an opportunistic tool used for the assessment of low muscle mass criteria of sarcopenia in cancer patients, while nutritional ultrasound (NU) cutoff points for sarcopenia have been recently proposed. The objective of the present review is to evaluate if NU has a comparable accuracy as CT for the assessment of sarcopenia in cancer patients and could be useful in clinical setting.<h4>Methods</h4>Systematic review was registered in Open Science Framework. PubMed and Scopus databases were searched in May and updated in August 2025. All published studies in which patients were evaluated using only one of the previously mentioned modalities, or those involving subjects with non-cancer-related pathologies, were excluded. Two reviewers independently evaluated the risk of bias of selected studies with the National Institutes of Health (NIH) Quality Assessment Tools, and results are presented following the PRISMA 2020 model for systematic reviews.<h4>Results</h4>Six studies comprising a total of 1011 patients (57.27% male) were evaluated. Accuracy, variability, and agreement between NU and CT are presented.<h4>Conclusions</h4>Main limitations of the evidence include the heterogeneity among studies and their risk of bias. Nevertheless, NU can be a useful tool for sarcopenia diagnosis and can provide a closer and a more flexible follow-up in cancer patients than CT.