磁共振成像对口腔癌下颌骨骨侵犯诊断价值的系统评价

Systematic review of magnetic resonance imaging in diagnosing mandibular invasion caused by oral cancers

目的通过系统评价的方法,探讨磁共振（MR）在口腔癌下颌骨骨侵犯诊断中的价值。方法通过对Medline、荷兰医学文摘（EMBASE）、欧洲灰色文献数据库（SIGLE）、中国生物医学文献数据库等进行相关文献的电子检索。同时手工检索19种中文口腔医学期刊。两位研究者分别独立完成文献纳入排除并提取数据,运用MetaDisc 1.4对MR在口腔癌下颌骨骨侵犯诊断的敏感度（SEN）和特异度（SPE）及95%可信区间（95%CI）等进行分析。结果共纳入相关文献研究12篇,其中前瞻性研究5篇,回顾性研究7篇,共涉及患者476名,所有文献偏倚风险均为中度。Meta分析结果显示MR诊断口腔癌下颌骨骨侵犯的SEN为0.779（95%CI：0.719~0.831）,SPE为0.823（95%CI：0.767~0.870）,合并阳性似然比（＋LR）为3.442（95%CI：2.181~5.431）,合并阴性似然比（-LR）为0.286（95%CI：0.181~0.451）,合并诊断比值比（DOR）为25.702（95%CI：13.406~49.273）,曲线下面积（AUC）为0.903 9,Q＊值为0.835 4。因仅有2篇研究报告了MR在口腔癌下颌骨骨髓侵犯中的诊断效能,报告文献较少,故未行相关Meta分析,2篇研究包含55例患者,其SEN为0.838,SPE为0.722。结论 MR诊断口腔癌的下颌骨骨侵犯有较高的诊断效能,对口腔癌的下颌骨骨侵犯的术前评估有一定临床价值。

Objective To evaluate the diagnostic value of magnetic resonance（MR） imaging in the diagnosis of mandibular invasion caused by oral cancers. Methods Medline, EMBASE, SIGLE, and Chinese biomedical literature database were searched electronically. Manual searching for 19 relevant Chinese journals was also performed. Two reviewers evaluated the literature and extracted the data. Meta-Disc 1.4 was chosen to conduct the sensitivity（SEN）, specificity（SPE）, and 95% confidence interval（95%CI）. Results Twelve studies with a total of 476 patients, namely, 5 prospective studies and 7 retrospective studies, were included. All the studies had unclear risk of bias. Meta-analysis result showed that the combination of SEN of MR in diagnosing mandibular invasion was 0.779（95%CI： 0.719-0.831）, combination of SPE was 0.823（95%CI： 0.767-0.870）, positive likelihood ratio was 3.442（95%CI： 2.181-5.431）, negative likelihood ratio was 0.286（95%CI： 0.181-0.451）, and diagnostic odds ratio was 25.702（95%CI： 13.406-49.273）. The area under curve was 0.903 9 and Q＊ was 0.835 4. Meta-analysis was not processed when diagnosing mandibular medullary invasion because only two studies with 55 patients had been reported. The SEN was 0.838, and the SPE was 0.722. Conclusion MR is efficient and has clinical value in the diagnosis of mandibular invasion caused by oral cancer.