超声弹性成像应变率比值法判断乳腺包块良恶性价值的meta分析

Diagnostic significance of ultrasound elastography strain ratio for benign and malignant breast lesions:a meta-analysis

目的评价超声弹性成像(UE)的应变率比值法(SR)对乳腺包块良恶性的诊断价值。方法计算机检索Pub Med、The Cochrane Library(2017年6期)、EMbase、中国知网(CNKI)、维普期刊资源综合服务平台(VIP)、中国生物医学文献数据库(CBM)、万方数据库等中关于SR诊断乳腺包块的诊断准确性试验,检索时限为各数据库建库至2017年6月。由两位研究者独立筛选文献、提取资料和评价纳入研究的方法学质量后,运用Stata 12.0和Meta-Di Sc 1.4软件进行meta分析,合并指标包括灵敏度(sensitivity,Sen)、特异度(specificity,Spe)、阳性似然比(positive likelihood ratio,LR+)、阴性似然比(negative likelihood ratio,LR–)及诊断性比值比(diagnostic odds ratio,DOR)。结果本meta分析纳入了26项研究。meta分析结果显示,SR诊断乳腺包块的Sen合并=0.88[95%CI为(0.87,0.90),P<0.000 1]、Spe_(合并)=0.85[95%CI为(0.84,0.86),P<0.000 1]、LR+合并=6.66[95%CI为(5.26,8.43),P<0.000 1)]、LR–合并=0.14[95%CI为(0.11,0.17),P<0.000 1]、DOR_(合并)=53.37[95%CI为(34.96,81.49),P<0.000 1]。结论当前的证据显示,UE的SR对乳腺包块良恶性的诊断准确性较高,值得在临床推广。

Objective To evaluate the significance of the ultrasound elastography （UE） strain ratio （SR） in the diagnosis of breast nodule by meta-analysis. Methods A computer-based online search was conducted in PubMed, The Cochrane Library （Issue 6, 2017）, EMbase, CNKI, VIP, CBM, WanFang data databases, and so on （establishment time to June 2017）, to collect the relevant diagnostic trials of the SR for breast nodules. Two reviewers independently screened literatures, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was performed by using Stata 12.0 and Meta-Disc 1.4 software, and the combined indexes included sensitivity （Sen）, specificity （Spe）, positive likelihood ratio （LR＋）, negative likelihood ratio （LR-）, and diagnostic odds ratio （DOR）. Results A total of 26 studies were finally included. The results ofmeta-analysis showed that, the pooled Sen, Spe, LR＋, LR-, and DOR was 0.88 （95% C/was 0.87 to 0.90）, 0.85 （95% C/was 0.84 to 0.86）, 6.66 （95% C/was 5.26 to 8.43）, 0.14 （95% C/was 0.11 to 0.17）, and 53.37 （95% CI was 34.96 to 81.49）, respectively, P〈0.000 1. Conclusion SR has high diagnostic accuracy in the differential diagnosis of benign and malignant breast nodules, it is worthy of widely utilized in the clinic.