超声弹性成像对乳腺癌腋窝淋巴结转移诊断价值的系统评价

Diagnostic value of ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer: a systematic review

目的系统评价超声弹性成像在乳腺癌腋窝淋巴结转移中的诊断价值。方法计算机检索The Cochrane Library、Pub Med、CNKI、Wan Fang Data、VIP、Meda Link和CBM数据库,搜集超声弹性成像诊断乳腺癌腋窝淋巴结转移的诊断性试验,检索时限均为建库至2016年10月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Meta Disc 1.4软件进行Meta分析。结果共纳入9个研究,共735枚淋巴结。Meta分析结果显示,超声弹性成像诊断乳腺癌腋窝淋巴结转移的Sen_(合并)、Spe_(合并)、+LR、–LR和DOR_(合并)分别为0.82[95%CI(0.78,0.86)]、0.76[95%CI(0.72,0.81)]、3.32[95%CI(2.57,4.27)]、0.25[95%CI(0.20,0.31)]和14.77[95%CI(10.20,21.38)],SROC曲线下面积AUC为0.874 1。结论超声弹性成像对乳腺癌腋窝淋巴结转移诊断有较高的敏感性和特异性,其可用于乳腺癌腋窝淋巴结转移的鉴别诊断。

Objective To systematically review the diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer. Methods We electronically searched the databases including The Cochrane Library, PubMed, CNKI, WanFang Data, VIP, MedaLink and CBM for studies about diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then meta-analysis was performed using MetaDisc 1.4 software. Results A total of 9 studies involving 735 lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio and DOR were 0.82 （95%CI 0.78 to 0.86）, 0.76 （95%CI 0.72 to 0.81）, 3.32 （95%CI 2.57 to 4.27）, 0.25 （95%CI 0.20 to 0.31）, and 14.77 （95%CI 10.20 to 21.38）, respectively. The AUC of the SROC curve was 0.8741. Conclusion Ultrasonographic elastography has high sensitivity and specificity in the differential diagnosis of axillary lymph nodes in breast cancer, which indicates that it can be used to diagnosis axillary lymph nodes in breast cancer.