摘要
目的应用Meta分析方法评价超声双重造影用于胃癌术前T分期的诊断价值。资料与方法计算机检索中国知网、万方、维普、PubMed、Cochrane图书馆、Medline、Embase等数据库,检索时间为2000年1月1日—2018年3月31日。搜集超声双重造影对胃癌术前T分期的诊断性试验。对文献进行异质性检验和质量评价,合并效应量,绘制受试者工作特征曲线并进行综合分析。结果最终纳入8篇文献,共计1508例研究对象。超声双重造影诊断T1期胃癌的合并敏感度为0.80(95%CI 0.74～0.86)、特异度为0.99(95%CI 0.98～0.99)、曲线下面积(AUC)为0.989;诊断T2期胃癌的合并敏感度为0.75(95%CI 0.70～0.79)、特异度为0.91(95%CI 0.89～0.93),AUC为0.815;诊断T3期胃癌的合并敏感度为0.84(95%CI 0.81～0.87)、特异度为0.87(95%CI 0.85～0.89)、AUC为0.940;诊断T4期胃癌的合并敏感度为0.90(95%CI 0.86～0.93)、特异度为0.97(95%CI 0.96～0.98)、AUC为0.971。结论超声双重造影在胃癌术前T分期中与病理分期的一致性较高,可作为胃癌术前分期较好的影像学检查手段。
Purpose To evaluate the diagnostic value of double contrast-enhanced ultrasonography in preoperative T staging of gastric cancer by Meta-analysis. Materials and Methods CNKI, Wanfang, VIP, PubMed, Cochrane Library, Medline, and Embase database were searched via computer, with the search time set from January 1, 2000 to March 31, 2018. Diagnostic trials of preoperative T staging of gastric cancer using double contrast-enhanced ultrasonography was searched, and the heterogeneity test and quality evaluation were performed on the literature. The effect size was combined and the receiver operating characteristic curve was drawn for comprehensive analysis. Results A total of 8 literature(1508 subjects) was included for the study. The combined sensitivity of double contrast-enhanced ultrasonography in the diagnosis of stage T1 gastric cancer was 0.80(95% CI 0.74-0.86), the specificity 0.99(95% CI 0.98-0.99), and AUC 0.989; the combined sensitivity in the diagnosis of stage T2 gastric cancer was 0.75( 95% CI 0.70-0.79), specificity 0.91(95% CI0.89-0.93), and AUC 0.815; the combined sensitivity in the diagnosis of stage T3 gastric cancer was 0.84(95% CI 0.81-0.87), specificity0.87(95% CI 0.85-0.89), and AUC 0.940; the combined sensitivity in the diagnosis of stage T4 gastric cancer was 0.90(95% CI 0.86-0.93), specificity 0.97(95% CI 0.96-0.98), and AUC 0.971. Conclusion Double contrast-enhanced ultrasonography demonstrated high consistency in application between preoperative T staging of gastric cancer and pathological staging, and can be used as a proper imageological examination method for preoperative staging of gastric cancer.
引文
[1]Chen WQ,Zheng RS,Zhang SW,et al.The incidences and mortalities of major cancers in China,2010,Chin J Cancer,2014,33(8):402-405.
[2]Hartgrink HH,Jansen EP,Van Grieken NC,et al.Gastric cancer.Lancet,2009,374(9688):477-490.
[3]Blazeby JM,Farndon JR,Donovan J,et al.A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma.Cancer,2000,88(8):1781-1787.
[4]李雪丹,崔玲玲,崔丽贺,等.不用低张药进行64层螺旋CT胃癌术前检查的评价.中国医学影像学杂志,2013,21(3):210-213.
[5]Kwee RM,Kwee TC.Imaging in local staging of gastric cancer:a systematic review.J Clin Oncol,2007,25(15):2107-2116.
[6]Cochrane Group.The Cochrane Methods Group on systematic review of screening and diagnostic tests:recommended methods.http://www.Cochrane.org/docs/sadtdoc1.html.
[7]Whiting P,Rutjes AW,Reitsma JB,et al.The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.BMCMed Res Methodol,2003,3(3):25.
[8]张超贤,郭李柯,秦咏梅,等.胃双重超声造影结合血清巨噬细胞炎症蛋白1与血管细胞黏附分子1检测对胃癌术前分期的价值.中国普通外科杂志,2016,25(4):573-580.
[9]王倩,周华玲,张东东,等.超声双重造影对胃癌术前分期的诊断意义.中华危重症医学杂志:电子版,2015,8(2):100-103.
[10]汪军虎.胃癌采用双超声造影进行术前T分期的准确性分析.实用癌症杂志,2015,30(10):1521-1523.
[11]王亮,黄品同,黄福光,等.超声双重造影与超声内镜对胃癌术前T分期的比较研究.中华超声影像学杂志,2011,20(11):957-961.
[12]Zheng Z,Yu Y,Lu M,et al.Double contrast-enhanced ultrasonography for the preoperative evaluation of gastric cancer:a comparison to endoscopic ultrasonography with respect to histopathology.Ann Surg Oncol,2011,202(5):605-611.
[13]陈瑞杰,黄品同,李艳萍,等.胃窗超声造影与超声双重造影对进展期胃癌术前T分期的比较.中华肿瘤杂志,2010,32(7):551-554.
[14]王成龙,杨勇明,崔健,等.双重超声造影在胃癌术前分期中的价值.中华肿瘤杂志,2009,31(9):701-704.
[15]黄品同,李艳萍,赵雅萍,等.超声双重造影对胃癌术前T分期的价值.中华超声影像学杂志,2008,17(1):33-36.
[16]Lim JS,Yun Mi-Jin,Kim MJ,et al.CT and PET in stomach cancer:preoperative staging and monitoring of response to therapy.Radiographics,2006,26(1):143-156.
[17]罗洪霞,倪双双,林益怡,等.胃肠道外间质瘤超声诊断价值.中国临床医学影像杂志,2010,21(6):438-439.
[18]毛建强,吴金荣.胃超声造影术前评估胃癌TNM分期47例.肿瘤学杂志,2008,14(11):916-917.
