磁共振成像DWI序列诊断乳腺癌淋巴结转移价值的Meta分析

Diagnostic Value of Diffusion Weighted Imaging Sequence for Assessing Lymph Node Metastases in Breast Cancer:A Meta-analysis

目的 采用Meta分析的方法综合评价磁共振成像DWI序列诊断乳腺癌淋巴结转移的价值。方法 计算机检索The Cochrane Library、Pub Med、EMbase、Web of Science等外文数据库以及CNKI、CBM、VIP、Wan Fang Data等中文数据库中关于磁共振成像DWI序列诊断乳腺癌淋巴结转移的文献,检索时间截止到2016年9月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料,采用QUADAS-2工具评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算（合并）敏感度、特异度、阳性似然比、阴性似然比、诊断比值比,绘制受试者工作特征曲线（SROC曲线）并计算曲线下面积（AUC）。结果 最终纳入21篇文献的25个研究。Meta分析结果显示,DWI序列诊断乳腺癌淋巴结转移的Sen（合并）=0.85[95%CI（0.80,0.89）]、Spe（合并）=0.83[95%CI（0.78,0.87）]、＋LR（合并）=4.99[95%CI（3.74,6.67）]、–LR（合并）=0.18[95%CI（0.13,0.24）]、DOR（合并）=3.32[95%CI（2.82,3.82）]、AUC=0.91[95%CI（0.88,0.93）]。亚组分析结果显示：DWI序列在高b值=750~1 000条件下诊断乳腺癌淋巴结转移的特异性高于b值=400~600;1.5T的DWI序列较3.0T的DWI序列对乳腺癌淋巴结转移的诊断有更高的敏感度及特异度。结论 磁共振成像DWI序列对诊断乳腺癌淋巴结转移具有明确的诊断价值,尤其是在b值=750~1 000或者低场强1.5T的条件下具有更高的诊断效能。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。

Objective To evaluate the values of diffusion weighted imaging （DWI） sequence in the diagnosis of node metastases in breast cancer by meta-analysis. Methods The articles concerning the diagnosis of node metastases by using DWI until September 2016 were searched in databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, VIP, WanFang Data and CNKI. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 （Quality Assessment of Diagnostic Accuracy Studies-2） tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled weighted sensitivity, specificity, and diagnostic odds ratio （DOR） were calculated, the summary receiver operating characteristic curve （SROC） was drawn and the area under the curve was calculated. Results A total of 21 articles were included, involving 25 studies. The results of meta-analysis showed that, the pooled sensitivity, specificity, DOR and area under SROC curve of DW1 for diagnosing node metastases were 0.85 （95%CI 0.80 to 0.89）, 0.83 （95%CI 0.78 to 0.87）, 4.99 （95%CI 3.74 to 6.67）, 0.18 （95%CI 0.13 to 0.24）, 3.32 （95%CI 2.82 to 3.82）, and 0.91 （95%CI 0.88 to 0.93）, respectively. The results of subgroup analysis showed that DWI had better Spe in b value =750-1 000 than b value =400-600; The 1.5T DWI had better Sen and Spe in diagnosing node metastases compared with 1.5T DWI. Conclusion DWI has more diagnostic efficiency for assessing lymph node metastases, especially in b value =750-1 000 and 1.5T field MR syetem. Due to limited quantity and quality of the included studies, more high-quality studies are required to verify the above conclusion.