增强能谱乳腺摄影与MRI诊断乳腺癌效能比较:Meta分析

Comparison of contrast-enhanced spectral mammography and MRI in diagnosis of breast cancer: Meta-analysis

目的采用Meta分析综合评价对比增强能谱乳腺摄影(CESM)与MRI对乳腺癌的诊断效能。方法检索中国知网数据库、万方数据库、中国生物医学文献服务系统、Cochrane Library、Web of Science等国内外数据库中近10年发表的CESM与MRI比较诊断乳腺癌效能的文献,采用Review Manager 5.3软件根据诊断准确性实验质量评价工具-2(QUADAS-2)评价文献质量,以Meta Disc 1.4检验纳入文献的异质性,并根据结果选择对应效应模型,对两种方法诊断乳腺癌的敏感度、特异度、阳性似然比(PLR)、阴性似然比(NLR)和诊断比值比(DOR)进行汇总分析,绘制诊断性实验Deek's漏斗图,对纳入文献的发表偏倚及其真实性进行评价。结果共检索出相关中英文文献661篇,经过筛选纳入12篇文献。汇总结果显示,CESM和MRI诊断乳腺癌的敏感度均为0.97,特异度分别为0.69和0.51,DOR分别为105.44和33.73,PLR分别为2.94和1.95,NLR分别为0.05和0.07,AUC(95%CI)分别为0.964 5(0.955 8,0.981 5)和 0.919 8 (0.892 7,0.946 8),CESM的AUC大于MRI。Deek's漏斗图表明纳入文献不存在明显发表偏倚(P >0.05)。结论 CESM能有效诊断乳腺癌,较MRI有一定优势。

Objective To observe the diagnostic efficacy of contrast-enhanced spectral mammography (CESM) and MRI for breast cancers using meta-analysis.Methods Literature of CESM and MRI in diagnosis of breast lesions were extracted in the databases,including CNKI,CBM,Cochrane Library,Web of Science and other domestic and foreign databases in recent 10 years.The software Review Manager 5.3 was used to evaluate the publication quality assessment according the quality assessment of diagnostic accuracy studies-2 (QUADAS-2).After testing the heterogeneity of enrolled literatures using Meta Disc 1.4,the sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) for diagnosis of breast cancers of these two methods were summarized,and the diagnostic experiment Deek's funnel chart was drawn to evaluate the publication bias and authenticity.Results A total of 661 papers were searched,and 12 were enrolled.The summarized results showed the sensitivity of CESM and MRI were both 0.97,the specificity was 0.69 and 0.51,the DOR was 105.44 and 33.73,PLR was 2.94 and 1.95,NLR was 0.05 and 0.07,and the AUC (95%CI) was 0.964 5 (0.955 8,0.981 5) and 0.919 8 (0.892 7,0.946 8),respectively.AUC of CESM was larger than that of MRI.Deek's funnel plot showed that the publication bias was not significant (P>0.05).Conclusion CEMS is a valuable diagnostic method for breast cancers which has certain advantages in some aspects compared with MRI.