单光子发射计算机断层成像在诊断口腔癌颌骨侵犯中的价值：系统评价及Meta分析

Single-photon emission computed tomography for the diagnosis of mandibular invasion caused by oral cancers: a systematic review and Meta-analysis

目的评价单光子发射计算机断层成像(SPECT)技术在诊断口腔癌下颌骨侵犯的诊断效能。方法对5个常用数据库进行电子检索,检索时间截至2016年8月5日;并对纳入研究参考文献进行手检。研究质量由两位评价者独立使用Cochrane协作网推荐的标准进行评价并提取数据。运用STATA 11.0软件进行Meta分析。结果共纳入10篇研究,共涉及患者460名。1项研究存在低偏倚风险,2项研究存在高偏倚风险,7项研究偏倚风险不清。合并敏感度为0.99[95%可信区间=0.87~1.00]。Meta分析结果显示,合并受试者工作特征曲线(SROC)的曲线下面积(AUC)为0.93[95%可信区间=0.90~0.95],Q*点处敏感度为0.99,特异度为0.61。其合并阳性预测值为2.555,合并阴性预测值为0.015,而合并诊断比值比为5.115。结论 SPECT在诊断口腔癌下颌骨侵犯中敏感度较高,适合用于排除没有骨侵犯存在的患者,但特异度低,不适合进行确诊,临床医生应该根据具体患者情况进行合理选择。

Objective This review aimed at assessing the diagnostic efficacy of contrast-enhanced single-photon emission computed tomography （SPECT） in the diagnosis of mandibular invasion by oral cancers. Methods Five databases were searched electronically on August 5, 2016. The reference lists of included studies were hand searched. Quality assessment was performed by two reviewers in duplicate with tools suggested by Cochrane＇s handbook. Furthermore, the data extraction of included studies was delivered. Meta-analysis was performed using STATA 11.0. Results Ten studies with 460 participants were included. One study had a low risk of bias, and two studies had a high risk of bias. The remaining seven studies had an unclear risk of bias. Meta-analysis results showed that SPECT had a pooled sensitivity of 0.99 [95% confidence interval=0.87- 1.00]. Sensitivity was 0.99 on Q＊ point. The specificity of 0.61 and the area under summary receiver operating characteristic curve （SROC） were 0.93 [95% confidence interval=0.90- 0.95]. The pooled positive likelihood ratio was 2.555. The negative likelihood ratio was 0.015. The diagnostic odd ratio was 5.115. Conclusion SPECT had high sensitivity, which became suitable for excluding bone invasion by oral cancers. However, its specificity was relatively low, indicating its limited capability in confirming diagnosis. Therefore, surgeons should perform this method under certain conditions.