基于18F-脱氧葡萄糖PET-CT成像对非小细胞肺癌纵隔淋巴结转移识别的Meta分析

The value of 18FDG PET-CT in the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer：a Meta-analysis

目的：检索文献通过Meta分析的方法评估PET-CT对于非小细胞肺癌（NSCLC）纵隔淋巴结转移的诊断价值。方法通过PubMed、EMBASE、Cochrane Library数据库收集2002年1月至2016年1月的有关PET-CT对NSCLC纵隔淋巴结诊断的文献，并通过纳入排除标准进行筛选，提取文献中真阳性数、假阳性数、假阴性数和真阴性数。使用STATA软件进行Meta统计分析，绘制受试者工作特征曲线并计算曲线下面积（AUC）。讨论异质性来源，并进行亚组分析。结果符合纳入标准的文献共计23篇（2959例患者），以患者为研究对象，诊断的敏感度和特异度分别是0.66（0.55～0.75）、0.84（0.79～0.89），AUC为0.84（0.80～0.87），亚组分析结果提示曾患肺结核是影响PET-CT诊断NSCLC纵隔淋巴结转移的一个重要影响因素（P=0.01）。结论 PET-CT对NSCLC纵隔淋巴结转移诊断分期准确度高，是NSCLC治疗决策前值得推荐的检查方法，但患者若曾患肺结核应谨慎对待。

Objective To assess the diagnostic value of mediastinal lymph node in non-small cell lung cancer using PET-CT by Meta-analysis. Methods Publications on mediastinal lymph node staging of non-small cell lung cancer by PET-CT published from January 2002 to January 2016 were filtered and assessed according to criteria from the PubMed, EMBASE, Cochrane library database. The number of true positive, false positive, false negative and true negative were extracted, meta-analysis was performed using STATA software, and receiver operating characteristic curve was applied, then area under the curve（AUC） was calculated. At last, heterogeneous sources were discussed and subgroup analyses were performed. Results Twenty-three relevant literatures（2 959 patients） were enrolled, the diagnostic sensitivity and specificity based on the patients were 0.66（0.55—0.75） and 0.84（0.79—0.89）, AUC was 0.84 （0.80—0.87）. The results of subgroup analysis suggested that pulmonary tuberculosis was one important factor that influenced the PET-CT diagnosis of mediastinal lymph node metastasis in NSCLC patients（P=0.01）. Conclusions PET-CT has a high accuracy for the mediastinal lymph node staging in non-small cell lung cancer, and it is the recommendedexamination method in these patients. Patients who had suffered from pulmonary tuberculosis should be treated with caution.