超声、钼靶X线及其联合应用诊断乳腺癌准确性的Meta分析

The accuracy of ultrasonography,molybdenum target x-ray and its combined application on diagnosis of breast cancer: A meta-analysis

目的:采用Meta分析方法评价超声、钼靶以及联合应用在乳腺癌诊断中的临床价值。方法:计算机检索Pub Med、Web of Science、The Cochrane Library、万方数据库、中国知网、中国生物医学文献数据库,并辅以手工检索,获取超声和钼靶在乳腺癌诊断的相关文献。依据诊断准确性研究的质量评估(QUADAS-2)工具进行文献质量评价。利用Meta-Disc1.4和Rev Man 5.2软件对超声和钼靶诊断乳腺癌的敏感性(SEN)、特异性(SPE)、阳性似然比(+LR)、阴性似然比(-LR)、诊断比值比(DOR)进行合并分析,并计算综合受试者工作特征(SROC)曲线下面积。结果:Meta分析结果显示,以术后病理检查为金标准,乳腺超声诊断乳腺癌的SEN合并为0.85(95%CI:0.84,0.86),SPE合并为0.93(95%CI:0.92,0.93),DOR为20.35(95%CI:13.62,30.4);钼靶X线诊断乳腺癌的SEN合并为0.81(95%CI:0.80,0.83),SPE合并为0.97(95%CI:0.97,0.97),DOR为19.49(95%CI:11.29,33.66);乳腺超声联合钼靶X线诊断乳腺癌的SEN合并为0.94(95%CI:0.93,0.95),SPE合并为0.93(95%CI:0.92,0.94),DOR为89.24(95%CI:46.14,172.63)。结论:乳腺超声和钼靶X线诊断乳腺癌的准确性较高,两者效果相当,联合应用更能有效地提高诊断乳腺癌的准确性。

Objective：To evaluate the clinical value of ultrasound, molybdenum target x-ray and its combined application for diag-nosis of breast cancer by meta-analysis. Methods： The relative studies of ultrasound, molybdenum target x-ray for diagnosis of breast can-cer were systematically searched in the following databases： PubMed（1966-2015.4）, Web of Science（1980-2015.4）, Cochrane Library （2015.4）, Wan Fang databases（1990-2015.4）, CNKI（1994-2015.4）,CBM（1978-2015.4）.The quality assessment of diagnostic accuracy studies（QUADAS-2） items were used to evaluate the quality of included studies. Meta-analysis was conducted by using Meta-disc 1.4 and Rev-Man5.2 software, such as sensitivity（SEN）, specificity（SPE）, positive likelihood ratio（＋LR）, negative likelihood ratio（-LR）, diagnosis odds ra-tion （DOR）, etc. And then draw summary receiver operating characteristic（SROC） and calculate the area under the curve（AUC）. Results：With postoperative pathologic result as the gold standard, meta-analysis results showed that SEN, SPE, DOR, AUC of ultrasound in diagnosis for breast cancer were 0.85（95%CI：0.84, 0.86）, 0.93（95%CI：0.92, 0.93）, 20.35（95%CI：13.62, 30.4） respectively;and SEN, SPE, DOR, AUC of molybdenum target x-ray in diagnosis for breast cancer were 0.81（95%CI：0.80, 0.83）, 0.97（95%CI：0.97, 0.97）, 19.49（95%CI：11.29, 33.66） respectively;SEN, SPE, DOR, AUC of both combination in diagnosis for breast cancer were 0.94（95%CI：0.93, 0.95）, 0.93（95%CI：0.92, 0.94）, 89.24（95%CI：46.14, 172.63） respectively. Conclusion：Ultrasound and molybdenum target x-ray has almost the same high accuracy and ef-fects for diagnosis of breast cancer, and its combined application can effectively improve the accuracy of the diagnosis of the breast cancer.