论文部分内容阅读
目的采用Meta分析的方法综合评价磁共振成像DWI序列诊断乳腺癌淋巴结转移的价值。方法计算机检索The Cochrane Library、Pub Med、EMbase、Web of Science等外文数据库以及CNKI、CBM、VIP、Wan Fang Data等中文数据库中关于磁共振成像DWI序列诊断乳腺癌淋巴结转移的文献,检索时间截止到2016年9月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料,采用QUADAS-2工具评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算_(合并)敏感度、特异度、阳性似然比、阴性似然比、诊断比值比,绘制受试者工作特征曲线(SROC曲线)并计算曲线下面积(AUC)。结果最终纳入21篇文献的25个研究。Meta分析结果显示,DWI序列诊断乳腺癌淋巴结转移的Sen_(合并)=0.85[95%CI(0.80,0.89)]、Spe_(合并)=0.83[95%CI(0.78,0.87)]、+LR_(合并)=4.99[95%CI(3.74,6.67)]、–LR_(合并)=0.18[95%CI(0.13,0.24)]、DOR_(合并)=3.32[95%CI(2.82,3.82)]、AUC=0.91[95%CI(0.88,0.93)]。亚组分析结果显示:DWI序列在高b值=750~1 000条件下诊断乳腺癌淋巴结转移的特异性高于b值=400~600;1.5T的DWI序列较3.0T的DWI序列对乳腺癌淋巴结转移的诊断有更高的敏感度及特异度。结论磁共振成像DWI序列对诊断乳腺癌淋巴结转移具有明确的诊断价值,尤其是在b值=750~1 000或者低场强1.5T的条件下具有更高的诊断效能。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the value of MRA DWI in the diagnosis of lymph node metastasis of breast cancer by Meta-analysis. Methods A computer-based online search of foreign databases such as The Cochrane Library, Pub Med, EMbase and Web of Science and literature on CNKI, CBM, VIP and Wan Fang Data for the diagnosis of lymph node metastasis in breast cancer by DWI sequence of magnetic resonance imaging September 2016. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias in the included studies using the QUADAS-2 tool. Meta-analysis was performed using Stata 12.0 software to calculate _ (combined) sensitivity, specificity, positive Likelihood Ratio, Negative Likelihood Ratio, diagnostic odds ratio, plot the subject’s working characteristic curve (SROC curve) and calculate the area under the curve (AUC). Results Finally, 25 studies were included in 21 articles. Meta-analysis showed that the Sen_ (pooled) of DWI sequence for breast cancer lymph node metastasis was 0.85 [95% CI (0.80,0.89)], Spe_ (pooled) = 0.83 [95% CI (0.78,0.87)], (Pooled) = 4.99 [95% CI (3.74,6.67)], LR_ (pooled) = 0.18 [95% CI (0.13,0.24)], DOR_ (pooled) = 3.32 [95% CI (2.82,3.82) AUC = 0.91 [95% CI (0.88, 0.93)]. The results of subgroup analysis showed that the specificity of DWI sequence for diagnosis of lymph node metastasis of breast cancer was higher than that of b value = 400-600 under the condition of high b value = 750-1000; DWI sequence of 1.5T was better than 3.0T DWI sequence in breast cancer The diagnosis of lymph node metastasis has a higher sensitivity and specificity. Conclusion MRI DWI has a clear diagnostic value in the diagnosis of lymph node metastasis of breast cancer, especially in the condition of b value = 750-1000 or low field strength 1.5T. Due to the limited number and quality of studies involved, the above conclusion still needs to be verified by more high-quality studies.