彩色多普勒超声对女性乳腺癌诊断价值的Meta分析

Diagnostic Value of Color Doppler Ultrasonic for Female Breast Cancer:A Meta-Analysis

目的系统评价彩色多普勒超声用于女性乳腺癌诊断的临床价值。方法计算机检索he Cochrane Library(2013年第2期)、EMbase、PubMed、CNKI、WanFang Data、超星MedaLink、VIP和CBM,并且手工检索相关中文期刊,收集采用彩色多普勒超声与金标准(病理活检)比较诊断乳腺癌的诊断性试验,检索时限均为从1982年至2013年3月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料,然后采用QUADAS条目评价纳入研究的方法学质量,采用Meta-DiSc1.4软件对其敏感性(SEN)、特异性(SPE)、阳性似然比(+LR)、阴性似然比(LR)、诊断比值比(DOR)进行异质性检验和合并分析,绘制受试者工作特征(SROC)曲线,计算曲线下面积(AUC)。结果最终纳入25个研究,3 274例研究对象。Meta分析结果显示:SPE合并=0.76[95%CI(0.74,0.78)],SEN合并=0.80[95%CI(0.78,0.82)],+LR=3.58[95%CI(2.63,4.87)],LR=0.28[95%CI(0.22,0.35)],DOR合并=13.76[95%CI(8.47,22.36)],AUC为0.865 7。结论现有研究证实,彩色多普勒超声对女性乳腺癌有较高的敏感性(80%)和较高的特异性(76%)。乳腺癌组实验阳性的比值是非乳腺癌组实验阳性比值的13.76倍,说明其诊断判别效果好,可作为诊断乳腺癌有效,可行的方法。

Objective To systematically review the clinical value of color Doppler ultrasonic for diagnosing female breast cancer. Methods We electronicaaly searched the databases including The Cochrane Library （Issue 2, 2013）, EMbase, PubMed, CNKI, WanFang Data, MedaLink ,VIP and CBM for diagnostic tests on breast cancer diagnosed with color Doppler ultrasonic vs. with pathological biopsy （golden criteria） from 1982 to the March, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies according to QUADAS items. The Meta-DiSc software （version 1.4） was used to conduct pooling on sensitivity, specificity, positive likelihood radio, and negative likelihood radio. Heterogeneity test was performed and the summary receiver operating characteristic curve （SROC） was drawn for area under the curve （AUC）. Results A total of 25 studies involving 3 274 patients were included. The results of meta-analysis showed that, SPE, SEN, ＋LR, ？LR and DOR were （0.76, 95%CI 0.74 to 0.78）, （0.80, 95%CI 0.78 to 0.82）, （3.58, 95%CI 2.63 to 4.87）, （0.28, 95%CI 0.22 to 0.35） and （13.76, 95%CI 8.47 to 22.36）, respectively. The AUC of SROC curve was 0.865 7. Conclusion Current evidence shows that color Doppler ultrasonic has high sensitivity （80%） and high specificity （76%） in the diagnosis of high-frequency Ultrasound. The positive rate in the breast cancer group is 13.76 times as high as that in non-breast cancer, which indicates color Doppler ultrasonic has good diagnostic value for breast cancer.