CT结肠镜诊断结直肠肿瘤和息肉准确性的系统评价

Accuracy of computed tomographic colonography for the detection of polyps and colorectal tumors: A systematic review and Meta-analysis

目的：系统评价CT结肠镜用于结直肠肿瘤和息肉诊断的临床价值。方法：通过计算机检索及手工查阅，全面收集CT结肠镜用于结直肠肿瘤和息肉诊断的中英文文献，按纳入与排除标准筛选文献并提取纳入研究中有关准确度的数据，根据QUADAS条目进行质量评价，采用MetaDisc1．4软件检验研究间的异质性并进行Meta分析。结果：最终纳入英文文献22篇，中文文献0篇。异质性检验结果为Spearman相关系数=0．406，P=0．244，提示阈值效应引起的异质性较小，但是存在其他因素导致的异质性，按随机效应模型进行Meta分析。CTC结肠镜诊断结直肠肿瘤和息肉的敏感度和特异度分别为69％和83％，而且诊断的敏感度和特异度随着肿物大小的增加而增加，分别为62％～81％和90．1％～92．4％。结论：用CT结肠镜诊断结直肠肿瘤和息肉具有很高的特异性，但其敏感度波动范围很大。

OBJECTIVE：To perform a meta-analysis of the diagnostic accuracy of computed tomographic colonography（CTC） for the detec tion of polyps and colorectal tumors. METHODS： A comprehensive electronic search and additional manual tracking were performed to retrieve relevant studies on CTC in diagnosis of polyps and colorectal tumors in English and Chinese. The data about the accuracy of the included studies were extracted for further heterogeneity studies; statistical pooling and SROC （summary receiver operating characteristics） were analyzed using Meta Disc 1. 4 software. QUADAS was used for quality assessment. RESULTS Twenty-two studies were selected according to the inclusion criteria. Heterogeneity of threshold effect showed Spearman correlation coefficient was 0. 406 and P was 0. 244. Although the Heterogeneity of threshold effect was less, there were other factors contributed to the het erogeneity. A Meta-analysis was performed using the random effect model. The overall sensitivity and specificity of CTC was 69% and 83% respectively. The sensitivity and specificity increased progressively as polyp size increased： it was from 62% to 81% and from 90.1% to 92.4% respectively. CONCLUSION： CTC is highly specific for the detection of colorectal polyps and tumors, but the sensitivities of the studies were highly heterogeneous.