前哨淋巴结活检在早期外阴鳞状细胞癌诊断中应用价值的荟萃分析

Meta-analysis of application value of sentinel lymph node biopsy in early-stage vulval squamous cell carcinoma

目的 系统评价前哨淋巴结活检（SLNB）用于早期外阴鳞状细胞癌淋巴结转移诊断的临床价值.方法 以1990至2014为年限,检索Cochrane Library临床试验数据库、PubMed数据库、中国期刊全文数据库（CNKI）、万方等数据库及相关期刊中关于SLNB在早期外阴鳞状细胞癌中应用的文献,按照纳入和排除标准对文献进行筛选,使用Meta Disc 1.4软件进行荟萃分析.结果 通过检索获得文献共2 459篇,其中符合纳入标准文献29篇,包含英文文献28篇,中文文献1篇;23项研究为前瞻性,6项为回顾性,共包含1 371例早期外阴鳞癌患者.各项研究报道的SLNB用于早期外阴癌淋巴结转移诊断的敏感性为66.7％～100％,特异性均为100％.各项纳入研究结果无明显异质性（I2=12.8％,P =0.270）,使用固定效应模型进行合并的SLNB敏感性和特异性分别为0.94（95％ CI：0.91～0.96）和1.00（95％ CI：0.99 ～1.00）,计算汇总受试者操作特性（SROC）曲线下面积为0.987 0.亚组分析显示使用单一示踪剂和联合示踪剂的SLNB合并敏感性分别为0.92（95％ CI：0.85 ～0.97）和0.94（95％ CI：0.91～0.97）;在使用“超分期”病理技术和常规病理技术的研究中,合并敏感性分别为0.93（95％ CI：0.90～0.96）和0.97（95％ CI：0.90～1.00）.结论 SLNB对早期外阴鳞状细胞癌患者淋巴结转移具有很高的诊断价值,不同的SLNB技术具有相似的敏感性和特异性.

Objective To systematically review the clinical value of sentinel lymph node biopsy （SLNB） in diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva.Methods Cochrane library,biomedical database （EMbase）,PubMed,China national knowledge internet （CNKI）,Wang Fang database,《Gynecologic Oncology》,《National Medical Journal of China》and 《Chinese Journal of Obstetrics and Gynecology》 were searched for literatures from 1990 to 2014 concerning SLNB application in early-stage vulvar squamous cell carcinoma.Literatures were filtrated according to inclusive and exclusive criteria.Meta Disc 1.4 software was used for meta-analysis.Results A total of 2 459 literatures were obtained,out of which 29 were eligible for analysis,including 28 in English and 1 in Chinese.Twenty-three studies were prospective and 6 were retrospective,including 1 371 patients with early-stage squamous cell carcinoma of vulva.The sensitivity of SLNB for diagnosis of lymph node metastasis in early-stage vulvar cancer ranged from 66.7% to 100%,and the specificity were 100% in all studies.No significant heterogeneity was found among the results of enrolled studies （I2 =12.8%,P =0.270）.The data were pooled by fixed effect model,and the pooled sensitivity and specificity were 0.94 （95% CI：0.91-0.96） and 1.00 （95% CI：0.99-1.00）,respectively.The calculated area under curve （AUC） of summarized Receiver Operating Characteristic （ROC） was 0.987 0.Subgroup analysis showed that the pooled sensitivity of SLNB were 0.92 （95 % CI：0.85-0.97） and 0.94 （95 % CI：0.91-0.97） in studies using single and combined tracers,respectively,and that they were 0.93 （95% CI：0.90-0.96） and 0.97 （95% CI：0.90-1.00） in studies with and without ultra-staging techniques,respectively.Conclusions SLNB is a highly accurate technique for diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva.The sensitivity and specificity are similar in SLNBs using different techniques.