~(18)F-FDG PET/CT对口腔癌颈部淋巴结转移诊断价值的Meta分析
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摘要
目的:系统评价~(18)F-FDG PET/CT在口腔癌颈部淋巴结转移的诊断价值。方法:检索中国知网(CNKI)、万方、中文科技期刊数据库、PubMed、EMbase、The CochraneLibrary、Webof Science查找有关~(18)F-FDG PET/CT在口腔癌颈部淋巴结转移及分期的研究。由2名研究者按统一制定的分类标准独立进行文献处理,采用Stata13.0软件、Meta-Disc1.4软件进行Meta分析。结果:最终纳入14篇研究,纳入口腔癌颈部转移患者849例,其中以病人为单位研究9篇,共299名患者;以淋巴结为单位研究5篇,病理确诊颈部淋巴结1 965例。Meta分析结果显示,~(18)F-FDG PET/CT诊断口腔癌颈部淋巴结转移具有较高的敏感度和特异性。SEN_(合并)=0.81(95%CI:0.73～0.87)、SPE_(合并)=0.90(95%CI:0.83～0.94)、+LR_(合并)=7.9(95%CI:4.9～12.7)、-LR_(合并)=0.21(95%CI:0.15～0.30)、 DOR=37(95%CI:20～67)、SROC=0.91(95%CI:0.89～0.94)。结论:~(18)F-FDG PET/CT对口腔癌颈部淋巴结转移的诊断能力具有较高的敏感度和特异性,可作为口腔癌患者重要的术前评估手段。
Objective: To evaluate the value of ~(18)F-FDG PET/CT in the diagnosis of cervical lymph node metastasis of oral carcinoma. Methods:(CNKI), Wanfang, Chinese sci-tech journal database, PubMed, EMbase, The Cochrane Library and Web of Science were searched for ~(18)F-FDG PET/CT in cervical lymph node metastasis oral cancer. Literature screening, data extraction and literature quality evaluation were carried out independently by two researchers according to the unified classification criteria. Stata13.0 software and Meta-Disc1.4 software were used for Meta analysis. Results: 14 studies and 849 patients with cervical metastasis of oral cancer were included, including 9 patients with cervical metastasis, 5 patients with cervical lymph node, and 1965 patients with cervical lymph node proved pathologically. The results of Meta analysis showed that ~(18)F-FDG PET/CT had good sensitivity and specificity in the diagnosis of cervical lymph node metastasis of oral cancer. SEN=0. 81(95%CI:0.73-0.87), SPE = 0. 90(95%CI:0.83-0.94), + LR = 7. 9(95%CI:4.9-12.7),-LR = 0. 21(95%CI:0.15-0.30), DOR=37(95%CI:20-67), SROC=0.91(95%CI:0.89-0.94). Conclusion: ~(18)F-FDG PET/CT has high sensitivity and specificity in the diagnosis of cervical lymph node metastasis, and can be used as an important preoperative evaluation method for oral cancer.
Objective: To evaluate the value of ~(18)F-FDG PET/CT in the diagnosis of cervical lymph node metastasis of oral carcinoma. Methods:(CNKI), Wanfang, Chinese sci-tech journal database, PubMed, EMbase, The Cochrane Library and Web of Science were searched for ~(18)F-FDG PET/CT in cervical lymph node metastasis oral cancer. Literature screening, data extraction and literature quality evaluation were carried out independently by two researchers according to the unified classification criteria. Stata13.0 software and Meta-Disc1.4 software were used for Meta analysis. Results: 14 studies and 849 patients with cervical metastasis of oral cancer were included, including 9 patients with cervical metastasis, 5 patients with cervical lymph node, and 1965 patients with cervical lymph node proved pathologically. The results of Meta analysis showed that ~(18)F-FDG PET/CT had good sensitivity and specificity in the diagnosis of cervical lymph node metastasis of oral cancer. SEN=0. 81(95%CI:0.73-0.87), SPE = 0. 90(95%CI:0.83-0.94), + LR = 7. 9(95%CI:4.9-12.7),-LR = 0. 21(95%CI:0.15-0.30), DOR=37(95%CI:20-67), SROC=0.91(95%CI:0.89-0.94). Conclusion: ~(18)F-FDG PET/CT has high sensitivity and specificity in the diagnosis of cervical lymph node metastasis, and can be used as an important preoperative evaluation method for oral cancer.
引文
1 Keshavarzi M,Darijani M,Momeni F,et al.Molecular Imaging and Oral Cancer Diagnosis and Therapy[J].J Cell Biochem,2017,118(10):3055-3060.
2 何保昌,高小叶,陈法.口腔癌发病影响因素病例对照研究[J].中国公共卫生,2014,30(2):248-250.
3 马大权.口腔癌的颈淋巴结处理[J].现代肿瘤医学,2004,12(2):81-82.
4 司家文,史宏璐,刘哲.磁共振弥散加权成像在口腔鳞癌颈部淋巴结转移中的初步应用[J].中国口腔颌面外科杂志,2012,10(4):311-315.
5 Baek CH,Chung MK,Son YI,et al.Tumor volume assessment by 18F-FDG PET/CT in patients with oral cavity cancer with dental artifacts on CT or MR images[J].Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2008,49(9):1422-1428.
6 Civantos FJ,Gomez C,Duque C,et al.Sentinel node biopsy in oral cavity cancer:correlation with PET scan and immunohistochemistry[J].Head Neck,2010,25(1):1-9.
7 Goerres GW,Schmid DT,Schuknecht B,et al.Bone invasion in patients with oral cavity cancer:comparison of conventional CT with PET/CT and SPECT/CT[J].Radiology,2005,231(1):281-287.
8 Seitz O,Chambron-Pinho N,Middendorp M,et al.18F-Fluorodeoxyglucose-PET/CT to evaluate tumor,nodal disease,and gross tumor volume of oropharyngeal and oral cavity cancer:comparison with MR imaging and validation with surgical specimen[J].Neuroradiology,2009,51(10):677-686.
9 Sch?der H,Carlson DL,Kraus DH,et al.18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI[J].Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2006,47(5):755-762.
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11 Hlawitschka M,Neise E,Bredow J,et al.FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes[J].Molecular Imaging and Biology,2002,4(1):91-98.
12 王淑侠,唐安戊,乔穗宪,等.18F-FDG PET舌癌术前分期、颈部淋巴结转移判定应用评价[J].中国医学影像技术,2003,19(1):25-26.
13 Sh N,Tc Y,Ct L,et al.18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma:A prospective study of 124 patients with histologic correlation[J].The JournalofNuclearMedicine,2005,(7):1136-1143.
14 Krabbe CA,Dijkstra PU,Pruim J,et al.FDG PET in oral and oropharyngeal cancer.Value for confirmation of N0 neck and detection of occult metastases[J].Oral Oncology,2006,44(1):31-36.
15 王欣璐,王全师,吴湖炳,等.口腔鳞癌的18F-FDG PET/CT的影像学表现以及与CT平扫的比较研究[J].实用放射学杂志,2006,22(8):995-998.
16 Piao YN,Bold B,Tayier A,et al.Evaluation of 18F-FDG PET/CT for diagnosing cervical nodal metastases in patients with oral cavity or oropharynx carcinoma[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology,and Endodontology,2009,108(6):933-938.
17 朱李军,陈仲伟,侯庆仪.PET在舌癌患者颈部淋巴结转移判定中的应用评价:与CT/MRI和临床触诊的对比[J].南方医科大学学报,2009,29(11):2228-2230.
18 Ct L,Hm W,Sf H,et al.PET and PET/CT of the neck lymph nodes improves risk prediction in patients with squamous cell carcinoma of the oral cavity[J].The Journal of Nuclear Medicine,2011,(2):180-187.
19 陈仲伟,徐冬贵,朱李军.PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值[J].中国口腔颌面外科杂志,2012,10(6):484-487.
20 Joo YH,Yoo IR,Cho KJ,et al.Extracapsular spread and FDG PET/CT correlations in oral squamous cell carcinoma[J].Int J Oral Maxillofac Surg,2013,42(2):158-163.
21 Kanda T,Kitajima K,Suenaga Y,et al.Value of retrospective image fusion of (1)(8)F-FDG PET and MRI for preoperative staging of head and neck cancer:comparison with PET/CT and contrast-enhanced neck MRI[J].Eur J Radiol,2013,82(11):2005-2010.
22 卢晓林,刘锐,孙方方.PET-CT显像在口腔颌面部恶性肿瘤患者颈淋巴结转移诊断中的价值[J].江苏医药,2014,40(8):908-910.
23 Schlittenbauer T,Zeilinger M,Nkenke E,et al.Positron emission tomography-computed tomography versus positron emission tomography-magnetic resonance imaging for diagnosis of oral squamous cell carcinoma:A pilot study[J].J Craniomaxillofac Surg,2015,43(10):2129-2135.
24 郑冬,牛力璇,费军.PET/CT在舌癌诊断及分期中的应用[J].中国医学影像学杂志,2017,25(7):496-500,504.
25 Hong HR,Jin S,Koo HJ,et al.Clinical values Of18F-FDG PET/CT in oral cavity cancer with dental artifacts on CT or MRI[J].JSurgOncol,2014,110(6):696-701.
26 Hyde NC,Prvulovich E,Newman L,et al.A new approach to pre-treatment assessment of the N 0 neck in oral squamous cell carcinoma:the role of sentinel node biopsy and positron emission tomography[J].Oral Oncology,2003,39(4):350-360.
2 何保昌,高小叶,陈法.口腔癌发病影响因素病例对照研究[J].中国公共卫生,2014,30(2):248-250.
3 马大权.口腔癌的颈淋巴结处理[J].现代肿瘤医学,2004,12(2):81-82.
4 司家文,史宏璐,刘哲.磁共振弥散加权成像在口腔鳞癌颈部淋巴结转移中的初步应用[J].中国口腔颌面外科杂志,2012,10(4):311-315.
5 Baek CH,Chung MK,Son YI,et al.Tumor volume assessment by 18F-FDG PET/CT in patients with oral cavity cancer with dental artifacts on CT or MR images[J].Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2008,49(9):1422-1428.
6 Civantos FJ,Gomez C,Duque C,et al.Sentinel node biopsy in oral cavity cancer:correlation with PET scan and immunohistochemistry[J].Head Neck,2010,25(1):1-9.
7 Goerres GW,Schmid DT,Schuknecht B,et al.Bone invasion in patients with oral cavity cancer:comparison of conventional CT with PET/CT and SPECT/CT[J].Radiology,2005,231(1):281-287.
8 Seitz O,Chambron-Pinho N,Middendorp M,et al.18F-Fluorodeoxyglucose-PET/CT to evaluate tumor,nodal disease,and gross tumor volume of oropharyngeal and oral cavity cancer:comparison with MR imaging and validation with surgical specimen[J].Neuroradiology,2009,51(10):677-686.
9 Sch?der H,Carlson DL,Kraus DH,et al.18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI[J].Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine,2006,47(5):755-762.
10 Whiting PF,Weswood ME,Rutjes AW,et al.QUADAS评价:一种用于诊断性研究的质量评价工具(修订版)[J].中国循证医学杂志,2007,7(7):531-536.
11 Hlawitschka M,Neise E,Bredow J,et al.FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes[J].Molecular Imaging and Biology,2002,4(1):91-98.
12 王淑侠,唐安戊,乔穗宪,等.18F-FDG PET舌癌术前分期、颈部淋巴结转移判定应用评价[J].中国医学影像技术,2003,19(1):25-26.
13 Sh N,Tc Y,Ct L,et al.18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma:A prospective study of 124 patients with histologic correlation[J].The JournalofNuclearMedicine,2005,(7):1136-1143.
14 Krabbe CA,Dijkstra PU,Pruim J,et al.FDG PET in oral and oropharyngeal cancer.Value for confirmation of N0 neck and detection of occult metastases[J].Oral Oncology,2006,44(1):31-36.
15 王欣璐,王全师,吴湖炳,等.口腔鳞癌的18F-FDG PET/CT的影像学表现以及与CT平扫的比较研究[J].实用放射学杂志,2006,22(8):995-998.
16 Piao YN,Bold B,Tayier A,et al.Evaluation of 18F-FDG PET/CT for diagnosing cervical nodal metastases in patients with oral cavity or oropharynx carcinoma[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology,and Endodontology,2009,108(6):933-938.
17 朱李军,陈仲伟,侯庆仪.PET在舌癌患者颈部淋巴结转移判定中的应用评价:与CT/MRI和临床触诊的对比[J].南方医科大学学报,2009,29(11):2228-2230.
18 Ct L,Hm W,Sf H,et al.PET and PET/CT of the neck lymph nodes improves risk prediction in patients with squamous cell carcinoma of the oral cavity[J].The Journal of Nuclear Medicine,2011,(2):180-187.
19 陈仲伟,徐冬贵,朱李军.PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值[J].中国口腔颌面外科杂志,2012,10(6):484-487.
20 Joo YH,Yoo IR,Cho KJ,et al.Extracapsular spread and FDG PET/CT correlations in oral squamous cell carcinoma[J].Int J Oral Maxillofac Surg,2013,42(2):158-163.
21 Kanda T,Kitajima K,Suenaga Y,et al.Value of retrospective image fusion of (1)(8)F-FDG PET and MRI for preoperative staging of head and neck cancer:comparison with PET/CT and contrast-enhanced neck MRI[J].Eur J Radiol,2013,82(11):2005-2010.
22 卢晓林,刘锐,孙方方.PET-CT显像在口腔颌面部恶性肿瘤患者颈淋巴结转移诊断中的价值[J].江苏医药,2014,40(8):908-910.
23 Schlittenbauer T,Zeilinger M,Nkenke E,et al.Positron emission tomography-computed tomography versus positron emission tomography-magnetic resonance imaging for diagnosis of oral squamous cell carcinoma:A pilot study[J].J Craniomaxillofac Surg,2015,43(10):2129-2135.
24 郑冬,牛力璇,费军.PET/CT在舌癌诊断及分期中的应用[J].中国医学影像学杂志,2017,25(7):496-500,504.
25 Hong HR,Jin S,Koo HJ,et al.Clinical values Of18F-FDG PET/CT in oral cavity cancer with dental artifacts on CT or MRI[J].JSurgOncol,2014,110(6):696-701.
26 Hyde NC,Prvulovich E,Newman L,et al.A new approach to pre-treatment assessment of the N 0 neck in oral squamous cell carcinoma:the role of sentinel node biopsy and positron emission tomography[J].Oral Oncology,2003,39(4):350-360.