摘要
目的采用meta分析的方法评价常规超声、超声弹性成像以及二者联合对乳腺结节良恶性的诊断价值。方法通过检索中文数据库(中国生物医学文献数据库、中国知网、维普、万方数据库)和英文数据库(EMBASE、PubMed、Cochrane图书馆、Web of Science),查找从建库至2021年4月20日期间有关常规超声和超声弹性成像鉴别乳腺良恶性病变的文献,严格按照纳入和排除标准筛选文献,提取数据,进行质量评估。采用Meta-DiSc1.4进行异质性分析以及数据合并分析,计算合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比及其95%CI,绘制森林图和拟合受试者工作特征(summary receiver operating characteristic,SROC)曲线并计算曲线下面积。采用StataSE14.0软件绘制Deek’s漏斗图评估发表偏倚,使用Fagan’s列线图评价各检测方法临床效用。结果共入选42项研究,涉及5118例患者共6009个病灶。常规超声、超声弹性成像以及两者联合的合并敏感度分别为0.80[95%CI为(0.79,0.82)]、0.87[95%CI为(0.86,0.89)]和0.93[95%CI为(0.91,0.94)],合并特异度分别为0.75[95%CI为(0.73,0.76)]、0.85[95%CI为(0.84,0.86)]和0.94[95%CI为(0.93,0.95)],综合ROC曲线下面积分别为0.86、0.94和0.98,三者诊断效能差异均有统计学意义(均P<0.05)。Deek’s漏斗图提示不存在发表偏倚(均P>0.05)。常规超声、超声弹性成像及两者联合的验前概率均为20%,验后概率分别为49%、66%和82%。结论超声弹性成像鉴别乳腺结节良恶性的准确性优于常规超声,但二者联合应用的准确性更高,值得在临床上推广运用。
Objective To evaluate the diagnostic value of conventional ultrasound,ultrasound elastography and their combination in benign and malignant breast nodules using meta-analysis.Methods The English databases(EMBASE,PubMed,Cochrane Library)and Chinese databases(China Biomedical Literature Database,China HowNet,VIP,Wanfang Database)were searched to collect the Chinese and English literatures about the diagnostic value of conventional ultrasound and elastography in differentiating the benign and malignant breast lesions up to April 20,2021,the reviewers strictly followed the inclusion and exclusion criteria to screen the literature,extract the data and conduct quality assessment.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and 95%CI were calculated by using meta-DiSc1.4 software for heterogeneity analysis and data combining analysis.The forest map and receiver operating characteristic(ROC)curve was drew,and the area under the ROC curve was calculated.StataSE14.0 software was used to draw deek funnel plot to evaluate publication bias,and Fagan’s nomogram was used to evaluate the clinical utility of each test method.Results A final selection of 42 articles involving 6009 nodules in 5118 patients was included.The sensitivity for conventional ultrasound,elastosonography and two techniques combination was 0.80[95%CI(0.79,0.82)],0.87[95%CI(0.86,0.89)]and 0.93[95%CI(0.91,0.94)],respectively;with specificity of 0.75[95%CI(0.73,0.76)],0.85[95%CI(0.84,0.86)]and 0.94[95%CI(0.93,0.95)].The summery area under curve was 0.86,0.94 and 0.98,respectively.There were significant differences in the diagnostic efficiency among the three groups(all P<0.05).The Deek’s funnel plot showed no significant publication bias(all P>0.05).The pre-testprobability of conventional ultrasound,elastosonography and two techniques combination were both 20%,and the posttestprobability were 49%,66%,and 82%,respectively.Conclusions The accuracy of elastography in distinguishing benign from malignant breast nodule is relatively high,while the accuracy of benign and malignant nodules in conventional ultrasound is generally acceptable.However,the accuracy of the combination of the two is higher,which is worthy of clinical application.
作者
杨艳
曹伟
吴欢
马爱琳
刘亭
张慧
刘环
YANG Yan;CAO Wei;WU Huan;MA Ailin;LIU Ting;ZHANG Hui;LIU Huan(The First People’s Hospital of Kashgar,Kashgar,Xinjiang Uygur Autonomous Region 844000,P.R.China;Sun Yixian Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2022年第4期481-489,共9页
Chinese Journal of Bases and Clinics In General Surgery
基金
喀什地区应用技术研究与开发计划项目(项目编号:KS2020002)。
关键词
乳腺良恶性结节
常规超声
弹性成像
诊断
META分析
benign and malignant breast lesions
conventional ultrasound
elastography
diagnosis
meta-analysis
