彩色多普勒超声检测乳腺癌腋窝前哨淋巴结价值的Meta分析

Value of Ultrasound in Diagnosis of Breast Cancer with Axillary Sentinel Lymph Nodes: A Meta-Analysis

目的系统评价彩色多普勒超声检测乳腺癌前哨淋巴结的价值,以期为临床决策提供依据。方法计算机检索PubMed、EMbase、The Cochrane Library(2013年12期)、CBM、CNKI、WanFang Data和VIP数据库,查找有关超声与病理(金标准)比较诊断乳腺癌前哨淋巴结的诊断性试验,检索时限截至2013年12月31日。由2位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析。结果共纳入12个研究,2 188例患者。Meta分析结果显示其合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.75[95%CI(0.72,0.77)]、0.91[95%CI(0.89,0.92)]、6.45[95%CI(4.68,8.89)]、0.22[95%CI(0.15,0.33)]和33.59[95%CI(17.87,63.12)],SROC曲线下面积(AUC)为0.934 3。结论彩色多普勒超声对乳腺癌淋巴结转移具有较高的诊断价值,但由于受纳入研究质量和各种潜在异质性因素的影响,该结论尚需进一步开展更多大样本、高质量研究进行验证。

Objective To systematically review the diagnostic value of ultrasound for breast cancer with axillary sentinel lymph nodes, so as to provide evidence for clinical decision-making. Methods We searched the databases in- cluding PubMed, EMbase, The Cochrane Library （Issue 12, 2013）, CBM, CNKI, WanFang Data and VIP for studies about ultrasound in the diagnosis of breast cancer with axillary sentinel lymph nodes till December 3 Vt, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and methodological quality of the included studies was evaluated. Meta-analysis was then conducted using Meta-Disc 1.4 software. Results A total of 12 studies involving 2 188 cases were included. The pooled results ofmeta-analysis showed that sensitivity and specificity were 0.75 （95%CI 0.72 to 0.77） and 0.91 （95%CI 0.89 to 0.92）, respectively; positive likelihood ratio and negative likelihood ratio were 6.54 （95%CI 4.68 to 8.89） and 0.22 （95%CI 0.15 to 0.33）, respectively; diagnostic odds ratio was 33.59 （95%CI 17.87 to 63.12） ; and the AUC was 0.934 3. Conclusion Ultrasound is has relatively high value in diagnosis of breast cancer with axillary sentinel lymph nodes. However, due to the influence caused by the limited quality and various potential het- erogeneity, more high quality RCTs with large sample size are needed to further verify the above conclusion.