细针穿刺细胞学检查诊断乳腺肿块良恶性价值的Meta分析

Diagnostic value of fine-needle biopsies for benign and malignant breast nodules: a meta-analysis

目的系统评价细针穿刺细胞学检查(FNAC)诊断乳腺肿块良恶性的价值。方法计算机检索Pub Med、The Cochrane Library(2016年7期)、EMbase、CBM、CNKI、VIP和Wan Fang Data数据库中关于FNAC诊断乳腺肿块良恶性的诊断准确性试验,检索时限均为建库至2016年8月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Stata 12.0和Meta-Di Sc 1.4软件进行统计分析。结果共纳入22个研究,共计24 496例乳腺肿块患者。Meta分析结果显示,FNAC诊断乳腺肿块的良恶性Sen_(合并)、Spe_(合并)、+LR_(合并)、–LR_(合并)和DOR_(合并)分别为:0.95[95%CI(0.95,0.96)]、0.96[95%CI(0.96,0.96)]、38.27[95%CI(23.17,63.19)]、0.05[95%CI(0.03,0.07)]和1 031.11[95%CI(514.19,2 067.68)],汇总受试者工作特征(SROC)曲线下面积AUC=0.99[95%CI(0.98,1.00)]。结论当前的证据显示,FNAC对乳腺肿块的诊断价值较高。

Objective To systematically review the value of the fine-needle biopsies in the diagnosis of benign and malignant breast nodules. Methods A computer based online search was conducted in PubMed, The Cochrane Library （Issue 7, 2016）, EMbase, CBM, CNKI, VIP, WanFang Data databases up to August, 2016 to collect the relevant diagnostic studies of the fine-needle biopsies for benign and malignant breast nodules. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using Stata 12.0 and Meta-Disc 1.4 software. Results A total of 22 studies involving 24 496 patients were finally included. The results of meta-analysis showed that the pooled Sen, Spe, ＋LR, -LR, and DOR were 0.95 （95%CI 0.95 to 0.96）, 0.96 （95%CI 0.96 to 0.96）, 38.27 （95%CI 23.17 to 63.19）, 0.05 （95%CI 0.03 to 0.07）, 1 031.11 （95%CI 514.19 to 2 067.68）, respectively. The AUC of SROC was 0.99 （95%CI 0.98 to 1.00）. Conclusion The current evidence indicates that the FNAC has high diagnostic value in the differential diagnosis of benign and malignant breast nodules.