Spyglass直视系统及Spybite目标活检对不明原因胆道狭窄良恶性鉴别的Meta分析

Spyglass visual impression and Spybite targeted biopsies for diagnosis of biliary strictures of unknown reasons： a meta-analysis

目的系统评价Spyglass直视系统及Spybite目标活检对于不明原因胆道狭窄良恶性鉴别诊断的临床价值。方法计算机检索多个中英文数据库，收集采用Spyglass直视系统或Spybite目标活检与金标准（病理活检、尸检或长期临床随访）对不明原因胆道狭窄良恶性鉴别的诊断性试验。采用QUADAS-2条目评价纳入研究的方法学质量，采用Meta-DiSc1．4软件对其敏感度（SEN）、特异度（SPE）、阳性似然比（＋LR）、阴性似然比（-LR）、诊断比值比（DOR）进行异质性检验和合并分析，绘制综合受试者工作特征（SROC）曲线，计算曲线下面积（AUC）。结果最终纳入12个研究，532例患者参与Spyglass直视系统诊断价值研究，525例患者参与Spybite目标活检诊断价值研究。Meta分析结果显示，Spyglass直视系统：合并SPE=0．90（95％CI：0．85-0．94），合并SEN=0．89（95％CI：0．85～0．93），合并PLR=7．12（95％CI：4．36-11．64），合并NLR=0．12（95％CI：0．07～0．22），合并DOR=82．40（95％CI：33．73～201．28），AUC为0．9574。Spybite目标活检：合并SPE=0．98（95％CI：0．96～1．00），合并SEN=0．66（95％CI：0．60～0．71），合并PLR=13．29（95％CI：6．92～25．53），合并NLR=0．37（95％CI：0．28—0．47），合并DOR=51．05（95％CI：23．58～110．53），AUC为0．9398。结论Spyglass直视系统善于探测到恶性病变，Spybite目标活检在确诊恶性病变上更具优势，两者结合可作为诊断不明原因胆道狭窄有效、可行的方法，但所得阴性结果不能完全除外恶性病变。

Objective To study the diagnostic value of Spyglass visual impression and Spybite targeted biopsies for biliary strictures of unknown reasons. Methods Several Chinese and English databases were electronically searched for studies on biliary strictures diagnosed with Spyglass visual impression and Spybite targeted biopsies compared with golden standard （pathological biopsy, autopsy and long-term clinical follow-up）. The methodological quality of the included studies was assessed according to QUADAS-2 items. The software Meta-DiSc （version 1.4） was used to conduct pooling on sensitivity, specificity, positive likelihood radio, negative likelihood radio arid diagnostic odds ratio （DOR）. Heterogeneity test was performed and the summary receiver operating characteristic curve （SROC） was drawn for area under the curve （AUC）. Results A total of 12 studies met the inclusion criteria, involving 532 patients who received Spyglass visual impression and 525 who received Spybite targeted biopsies. The combined specificity, sensitivity, positive likelihood ratio, negative likelihood ratio and DOR were 0. 90 （95%CI：0. 85-0. 94）, 0.89 （95%CI：0. 85-0.93）, 7.12 （95%CI： 4.36-11.64）, 0. 12 （ 95% CI： 0. 07-0. 22 ） and 82.40 （95% CI：33.73-201.28） for Spyglass visual impression, and 0. 98 （95%CI：0. 96-1.00）, 0. 66 （95%CI：0. 60- 0. 71 ）, 13.29 （95%CI： 6. 92-25.53）, 0. 37 （95%CI：0. 28-0. 47）and 51.05 （95%CI： 23.58-110. 53） for Spybite targeted biopsies, respectively. The AUC on the SROC of Spyglass visual impression and Spybite targeted biopsies were O. 957 4 and O. 939 8, respectively. Conclusion Spyglass visual impression is useful for detecting malignant lesion, whereas Spybite targeted biopsies is better at confirming malignant diagnosis, which indicates combination of the two methods have good diagnostic value for indeterminate biliary strictures, but their negative results are not perfect in excluding biliary cancer.