CT在良恶性孤立性肺结节鉴别诊断中的系统评价

Diagnostic value of computed tomography scanning in differentiating malignant from benign solitary pulmonary nodules:a systematic review with meta-analysis

目的应用Meta分析方法对胸部CT扫描中鉴别诊断孤立性肺结节(SPNs)良恶性的价值进行评价。方法收集并筛选出与CT扫描SPNs有关的文献,采用Metadisc、SPSS13及Stata10.0软件对数据进行分析,计算汇总灵敏度、特异度及其95%可信区间,绘制出汇总受试者工作特征曲线(SROC),计算曲线下面积,评价CT扫描对SPNs的诊断价值。结果按照制定标准共筛选出文献29篇,总体敏感度0.89(95%CI0.87～0.91),总体特异度0.69(95%CI0.66～0.72)。以动态增强扫描后SPNs净增CT值≥15Hu诊断为恶性的汇总灵敏度、特异度及95%可信区间为0.95(95%CI0.92～0.97),0.60(95%CI0.54～0.66);SPNs净增CT值≥20 Hu诊断为恶性的汇总灵敏度、特异度及95%可信区间为0.92(95%CI0.89～0.94),0.70(95%CI0.65～0.74)。结论胸部CT扫描对良恶性SPNs诊断价值较高,以15 Hu和20 Hu分别作为诊断阈值时,两者诊断价值无明显差异(P=0.511)。

Objective To evaluate the diagnostic value of computed tomography（CT） scanning in differentiating malignant from benign solitary pulmonary nodules（SPNs） by meta-analysis.Methods We searched for the related articles in English and Chinese literature on incremental dynamic CT scanning of the SPNs.The software of Metadisc,SPSS13 and Stata 10.0 was used.The pooled weighted sensitivity,pooled weighted specificity and the area under SROC curve（AUC） were used to evaluate the diagnostic performance of CT scanning of the SPNs.Results Altogether 29 articles in English and Chinese were included according to the criteria we made.The pooled weighted sensitivity was 0.89（95%CI 0.87-0.91） and the pooled weighted specificity was 0.69（95%CI 0.66-0.72）.The SPNs were considered as malignant when the value of incremental CT was above the threshold.The pooled weighted sensitivity of the two thresholds 15Hu and 20Hu was 0.95（95%CI 0.92-0.97）/0.92（95%CI 0.89-0.94）,and the pooled weighted specificity of them was 0.60（95%CI 0.54-0.66）/0.70（95%CI 0.65-0.74）,respectively.Conclusion Chest CT scanning is a good predictive indicator of malignancy in SPNs.The threshold of 15Hu for a positive test is similar to that of 20Hu（P=0.511）.