超声造影对浅表淋巴结良恶性鉴别的Meta分析
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摘要
目的评价超声造影对浅表淋巴结良恶性鉴别的价值。方法检索中国知网、万方、维普、PubMed、Cohchrane library等数据库,由2名检索员依据纳入和排除标准对检索得到的文献进行筛选,参照诊断性试验准确性质量评价工具(QUADAS)条目对纳入的文献进行质量评价,采用Meta Disc 1.4Version软件对纳入文献的原始数据进行汇总和计算,进而评价超声造影在浅表淋巴结良恶性鉴别中的价值。结果共有18篇文献纳入研究,中文文献12篇,英文文献6篇。各样本之间异质性较高,亚组分析后剔除良恶性淋巴结个数之比<1∶2的样本,剩余13个研究异质性较低,遂采用固定效应模型进行分析。汇总加权得到的合并灵敏度为0.88(95%CI=0.85~0.91),合并特异度为0.86(95%CI=0.82~0.89),阳性似然比为5.72(95%CI=4.58~7.14),阴性似然比为0.15(95%CI=0.12~0.19),诊断比值比为42.85(95%CI=29.87~61.46),合并受试者工作特征曲线下面积为0.927 9,Q指数为0.868 2。结论超声造影对浅表淋巴结良恶性的鉴别具有较高的价值。
Objective To assess the value of contrast-enhanced ultrasonography(CEU)in differential diagnosis of benign and malignant superficial lymph nodes. Methods Databases of CNKI,Wanfang,Veipu,PubMed and Cohchrane library were retrieved.According to the inclusion and exclusion criteria,the retrieved documents were screened by two search members.Referencing QUADAS entries,the quality of included literatures were evaluated.Employing Meta Disc 1.4Version software,the original data included in the literatures were summarized and calculated,and the value of CEU in differential diagnosis of benign and malignant superficial lymph nodes was evaluated. Results A total of 18 articles were included in the study,12 in Chinese and six in English.After the samples with the ratio of benign and malignant lymph nodes of<1∶2were removed,the rest 13 were with low research heterogeneity,a fixed effect model was then adopted for analysis.The combined sensitivity obtained from summary weighting was 0.88(95%CI=0.85-0.91),combined specificity was 0.86(95%CI=0.82-0.89),positive likelihood ratio was5.72(95%CI=4.58-7.14),and negative likelihood ratio was 0.15(95%CI=0.12-0.19),diagnostic accuracy and and odds ratio was 42.85(95%CI=29.87-61.46),the area under ROC curve was 0.927 9,and Q index was 0.868 2. Conclusion Contrastenhanced ultrasonography has a higher value in differential diagnosis of benign and malignant superficial lymph nodes.
Objective To assess the value of contrast-enhanced ultrasonography(CEU)in differential diagnosis of benign and malignant superficial lymph nodes. Methods Databases of CNKI,Wanfang,Veipu,PubMed and Cohchrane library were retrieved.According to the inclusion and exclusion criteria,the retrieved documents were screened by two search members.Referencing QUADAS entries,the quality of included literatures were evaluated.Employing Meta Disc 1.4Version software,the original data included in the literatures were summarized and calculated,and the value of CEU in differential diagnosis of benign and malignant superficial lymph nodes was evaluated. Results A total of 18 articles were included in the study,12 in Chinese and six in English.After the samples with the ratio of benign and malignant lymph nodes of<1∶2were removed,the rest 13 were with low research heterogeneity,a fixed effect model was then adopted for analysis.The combined sensitivity obtained from summary weighting was 0.88(95%CI=0.85-0.91),combined specificity was 0.86(95%CI=0.82-0.89),positive likelihood ratio was5.72(95%CI=4.58-7.14),and negative likelihood ratio was 0.15(95%CI=0.12-0.19),diagnostic accuracy and and odds ratio was 42.85(95%CI=29.87-61.46),the area under ROC curve was 0.927 9,and Q index was 0.868 2. Conclusion Contrastenhanced ultrasonography has a higher value in differential diagnosis of benign and malignant superficial lymph nodes.
引文
[1]朱玲,杜联芳,伍瑛,等.超声造影鉴别诊断浅表淋巴结良恶性的初步探讨[J].临床超声医学杂志,2012,14(12):816-819.
[2]张天嵩,钟文昭.Meta-Disc软件在诊断试验Meta分析中的应用[J].循证医学,2008,8(2):97-100.
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[4]邓小芸,赖玉琼,黄伟俊,等.超声造影对鼻咽癌颈部转移淋巴结的诊断价值[J].广东医学,2014,35(20):3186-3188.
[5]栗晨,王辉,栗玉彬.彩色多普勒超声及超声造影对甲状腺癌颈部淋巴结转移的诊断价值[J].中华超声影像学杂志,2014,23(10):918-919.
[6]张茂春.超声造影在颈部肿大淋巴结鉴别诊断中的临床研究[J].川北医学院学报,2013,28(4):354-358.
[7]冀鸿涛,朱强,荣雪余,等.超声造影在头颈部淋巴结良恶性病变鉴别诊断中的应用[J].中华医学超声杂志(电子版),2011,8(7):77-81.
[8]邢园园,何秀丽,祁明,等.超声造影对颈部肿大淋巴结良恶性的鉴别诊断[J].解放军医学院学报,2013(3):225-227.
[9]卢平平.常规超声和超声造影对浅表淋巴结良、恶性鉴别诊断的价值探讨[J].中国卫生产业,2014(29):184-185.
[10]肖晓云,智慧,杨海云,等.超声造影及弹性成像在浅表淋巴结鉴别诊断中的应用[J].岭南现代临床外科,2013,13(1):49-51.
[11]洪玉蓉,刘学明,张闻,等.超声造影定量分析在浅表淋巴结疾病鉴别诊断中的应用[J].中国超声医学杂志,2007,23(3):212-214.
[12]刘青,于铭,苏海砾,等.超声造影在浅表淋巴结定性诊断中的临床价值[J].中华超声影像学杂志,2009,18(2):142-145.
[13]张小红,王金萍,王如瑛.超声造影伽马拟合时间强度曲线对颈部浅表淋巴结病变的诊断价值[J].中国药物与临床,2015(2):171-174.
[14]赵建广,陈彦平,杨蕾,等.应用声诺维超声造影诊断口腔癌颈淋巴结转移的临床探讨[J].北京口腔医学,2015,23(1):36-39.
[15]CRISTINA D,SHEMA H,DAREN G,et al.Can contrastenhanced ultrasound distinguish malignant from reactive lymph nodes in patients with head and neck cancers[J]?Ultrasound in Medicine&Biology,2014,40(4):747-754.
[16]WEI X,LI Y,ZHANG S,et al.Prediction of thyroid extracapsular extension with cervical lymph node metastases(ECE-LN)by CEUS and BRAF expression in papillary thyroid carcinoma[J].Tumor Biology,2014,35(9):8559-8564.
[17]YU M,LIU Q,SONG H P,et al.Clinical application of contrast-enhanced ultrasonography in diagnosis of superficial lymph adenopathy[J].Journal of Ultrasound in Medicine,2010,29(5):735-740.
[18]XIANG D,HONG Y,ZHANG B,et al.Contrast-enhanced ultrasound(CEUS)facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients:diagnosis value and enhancement patterns of malignant lymph nodes[J].European Radiology,2014,24(10):2513-2519.
[19]SLAISOVA R,BENDA K,JARKOVSKY J,et al.Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy[J].European Journal of Radiology,2013,82(4):693-698.
[20]RUBALTELLI L,CORRADIN S,DORIGO A,et al.Automated quantitative evaluation of lymph node perfusion on contrast-enhanced sonography[J].American Journal of Roentge-nology,2007,188(4):977-983.
[21]洪玉蓉,刘学明.颈部转移性淋巴结的超声造影表现分析[J].中国超声医学杂志,2008,24(6):520-522.
[22]丁晶晶,杨宗利,房世保.超声造影对附件区良恶性包块的鉴别诊断价值[J].齐鲁医学杂志,2015,30(4):430-432.
[23]张俊鹏,刘春晖,孙咏梅.组织弥散定量技术在颈部淋巴结疾病诊断中的价值[J].青岛大学医学院学报,2016,52(1):61-63.
[2]张天嵩,钟文昭.Meta-Disc软件在诊断试验Meta分析中的应用[J].循证医学,2008,8(2):97-100.
[3]HIGGINS J P,THOMPSON S G,DEEKS J J,et al.Measu-ring inconsistency in meta-analyses[J].British Medical Journal,2003,327(7414):557-560.
[4]邓小芸,赖玉琼,黄伟俊,等.超声造影对鼻咽癌颈部转移淋巴结的诊断价值[J].广东医学,2014,35(20):3186-3188.
[5]栗晨,王辉,栗玉彬.彩色多普勒超声及超声造影对甲状腺癌颈部淋巴结转移的诊断价值[J].中华超声影像学杂志,2014,23(10):918-919.
[6]张茂春.超声造影在颈部肿大淋巴结鉴别诊断中的临床研究[J].川北医学院学报,2013,28(4):354-358.
[7]冀鸿涛,朱强,荣雪余,等.超声造影在头颈部淋巴结良恶性病变鉴别诊断中的应用[J].中华医学超声杂志(电子版),2011,8(7):77-81.
[8]邢园园,何秀丽,祁明,等.超声造影对颈部肿大淋巴结良恶性的鉴别诊断[J].解放军医学院学报,2013(3):225-227.
[9]卢平平.常规超声和超声造影对浅表淋巴结良、恶性鉴别诊断的价值探讨[J].中国卫生产业,2014(29):184-185.
[10]肖晓云,智慧,杨海云,等.超声造影及弹性成像在浅表淋巴结鉴别诊断中的应用[J].岭南现代临床外科,2013,13(1):49-51.
[11]洪玉蓉,刘学明,张闻,等.超声造影定量分析在浅表淋巴结疾病鉴别诊断中的应用[J].中国超声医学杂志,2007,23(3):212-214.
[12]刘青,于铭,苏海砾,等.超声造影在浅表淋巴结定性诊断中的临床价值[J].中华超声影像学杂志,2009,18(2):142-145.
[13]张小红,王金萍,王如瑛.超声造影伽马拟合时间强度曲线对颈部浅表淋巴结病变的诊断价值[J].中国药物与临床,2015(2):171-174.
[14]赵建广,陈彦平,杨蕾,等.应用声诺维超声造影诊断口腔癌颈淋巴结转移的临床探讨[J].北京口腔医学,2015,23(1):36-39.
[15]CRISTINA D,SHEMA H,DAREN G,et al.Can contrastenhanced ultrasound distinguish malignant from reactive lymph nodes in patients with head and neck cancers[J]?Ultrasound in Medicine&Biology,2014,40(4):747-754.
[16]WEI X,LI Y,ZHANG S,et al.Prediction of thyroid extracapsular extension with cervical lymph node metastases(ECE-LN)by CEUS and BRAF expression in papillary thyroid carcinoma[J].Tumor Biology,2014,35(9):8559-8564.
[17]YU M,LIU Q,SONG H P,et al.Clinical application of contrast-enhanced ultrasonography in diagnosis of superficial lymph adenopathy[J].Journal of Ultrasound in Medicine,2010,29(5):735-740.
[18]XIANG D,HONG Y,ZHANG B,et al.Contrast-enhanced ultrasound(CEUS)facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients:diagnosis value and enhancement patterns of malignant lymph nodes[J].European Radiology,2014,24(10):2513-2519.
[19]SLAISOVA R,BENDA K,JARKOVSKY J,et al.Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy[J].European Journal of Radiology,2013,82(4):693-698.
[20]RUBALTELLI L,CORRADIN S,DORIGO A,et al.Automated quantitative evaluation of lymph node perfusion on contrast-enhanced sonography[J].American Journal of Roentge-nology,2007,188(4):977-983.
[21]洪玉蓉,刘学明.颈部转移性淋巴结的超声造影表现分析[J].中国超声医学杂志,2008,24(6):520-522.
[22]丁晶晶,杨宗利,房世保.超声造影对附件区良恶性包块的鉴别诊断价值[J].齐鲁医学杂志,2015,30(4):430-432.
[23]张俊鹏,刘春晖,孙咏梅.组织弥散定量技术在颈部淋巴结疾病诊断中的价值[J].青岛大学医学院学报,2016,52(1):61-63.