经皮下注射超声造影剂诊断乳腺癌前哨淋巴结的Meta分析

Value of Ultrasound Contrast Agents Injected Subcutaneously for Diagnosing Sentinel Lymph Nodes of Breast Cancer:A Meta-analysis

目的系统评价经皮下注射超声造影剂在乳腺癌前哨淋巴结诊断中的价值。方法计算机检索Pub Med、EMbase、The Cochrane Library、CNKI、CBM、Wan Fang Data、超星Medalink数据库,收集经皮下注射超声造影剂诊断乳腺癌前哨淋巴结的临床研究,检索时限均为从建库到2014年7月。由两位研究者独立按照纳入与排除标准筛选文献、提取资料和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。结果最终纳入8个研究,共311个前哨淋巴结。Meta分析结果显示:SEN合并=0.89[95%CI(0.84,0.93)]、SPE合并=0.81[95%CI(0.72,0.87)]、+LR合并=4.14[95%CI(2.20,7.79)]、–LR合并=0.15[95%CI(0.10,0.25)、DOR合并=33.23[95%CI(11.17,98.83)]、SROC曲线下面积(AUC)=0.96。结论经皮下注射超声造影剂在诊断乳腺癌前哨淋巴结中具有较高的价值,受纳入研究数量和质量所限,本研究结论应开展更多高质量研究予以证实。

Objective To systematically review the value of ultrasound contrast agents injected subcutaneously for diagnosing sentinel lymph nodes of breast cancer. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, CBM, WanFang Data, and Medalink from their inception to July 2014, to collect diagnostic accuracy studies of ultrasound contrast agents injected subcutaneously for diagnosing sentinel lymph nodes of breast cancer. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using Meta- Disc 1.4 software. Results Eight studies involving 311 sentinel lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under curve （AUC） of SROC were 0.89 （95%CI 0.84 to 0.93）, 0.81 （95%CI 0.72 to 0.87）, 4.14 （95%CI 2.20 to 7.79）, 0.15 （95%CI 0.10 to 0.25）, 33.23 （95%CI 11.17 to 98.83）, and 0.96 respectively. Conclusion Contrast-enhanced ultrasound has a high value in diagnosis of sentinel lymph nodes of breast cancer. Due to limited quality and quantity of the included studies, more high quality and large-scale studies are needed to verify the above conclusion.