超声弹性成像对甲状腺癌淋巴结转移诊断价值的Meta分析

Ultrasonic elastography in the diagnosis of lymph node metastasis of thyroid cancer:A meta-analysis

目的 通过Meta分析系统评价超声弹性成像(UE)技术诊断甲状腺癌淋巴结转移的临床应用价值.方法 检索维普(VIP)、中国知网(CNKI)、万方、中国生物医学文献数据库(CBM)和英文数据库PubMed、Embase、Web of Science及Cochrane中有关超声弹性成像诊断甲状腺癌淋巴结转移研究的文献,检索时间为建库至2021年4月20日.预先设定好纳入和排除标准,由2名研究者严格筛选文献并提取数据,采用QUADAS-2风险评价工具评估纳入文献的偏倚风险,应用MetaDisc1.4、STATA 14软件和RevMan5进行Meta分析,并对发表偏倚及敏感性分析进行检验.结果 纳入18个诊断性研究,共计病灶4927个.Meta分析结果显示,超声弹性成像诊断甲状腺癌淋巴结转移的合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比分别为0.811 (0.789-0.832)、0.851(0.834-0.867)、5.014(3.815-6.590)、0.234(0.179-0.305)、23.413(14.291-38.358),SROC曲线下面积AUC=0.8970(Q指数=0.8281),Deek漏斗图显示本研究不存在明显发表偏倚(P=0.186).另外,有5项研究的结果显示超声弹性成像联合超声造影诊断甲状腺癌淋巴结转移的合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比分别为0.930(0.899-0.954)、0.901(0.877-0.922)、8.941 (7.200-11.104)、0.079 (0.054-0.115)、118.20 (73.923-188.99),合并AUC=0.9702(Q指数=0.9201),均优于两者单独使用.结论 超声弹性成像技术诊断甲状腺癌淋巴结转移具有较高灵敏度和特异度,尤其是与超声造影联合使用时具有更高的准确性,可推广用于甲状腺癌淋巴结转移的鉴别诊断.

Objective To evaluate the clinical value of ultrasonic elastography(UE)in the diagnosis of lymph node metastasis of thyroid cancer by meta-analysis.Methods The databases including the VIP,CNKI,Wanfang,CBM,PubMed,Embase,Web of Science and Cochrane were searched from establishment to April 20,2021.The inclusion and exclusion criteria were set in advance.Two researchers strictly screened the publications and extracted the cardinal data,QUADAS-2 risk assessment tool was used to evaluate the bias risk of all the studies,Metadisc 1.4,STATA 14 and RevMan5 were used to test meta-analysis,the publication bias and sensitivity analysis.Results A total of 18 diagnostic studies were included,with a total of 4927 lesions.Metaanalysis showed that the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio(DOR)of UE in the diagnosis of thyroid cancer with lymph node metastasis were 0.811(0.789-0.832),0.851(0.834-0.867),5.014(3.815-6.590),0.234(0.179-0.305)and 23.413(14.291-38.358),respectively.The area under the SROC curve was 0.8970(the Q index was 0.8281).The Deek's funnel showed there was no significant publication bias in this study(P=0.186).Furthermore,a total of five studies showed that the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and DOR of UE combined with contrast-enhanced ultrasound in the diagnosis of thyroid cancer with lymph node metastasis were 0.930(0.899-0.954),0.901(0.877-0.922),8.941(7.200-11.104),0.079(0.054-0.115),118.20(73.923-188.99),the area under the SROC curve was 0.9702(the Q index was 0.9201).Conclusions UE has a high diagnostic efficiency for detecting thyroid cancer with lymph node metastasis,especially when combined with contrast-enhanced ultrasound,which provides a feasible method for diagnosis of lymph node metastasis of thyroid cancer.