乳腺导管原位癌穿刺活检诊断低估相关因素的meta分析

Meta analysis of related factors of underestimation in the diagnosis of breast ductal carcinoma in situ by needle biopsy

目的系统评价造成乳腺导管原位癌(ductal carcinoma in situ,DCIS)穿刺病理学低估的相关因素,并通过控制相关因素降低DCIS的穿刺病理学低估率。方法计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、CNKI和万方数据库,搜集研究导致DCIS穿刺诊断低估的临床研究,检索时限从建库到2021年4月1日。由两名研究人员独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.4软件进行meta分析。结果共纳入24个研究,包括8810例患者。meta分析结果显示:年龄≥50岁[OR=0.82,95%CI为(0.70,0.96),P=0.020]、乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)分级≤4A级[OR=0.38,95%CI为(0.21,0.68),P=0.001]、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阴性[OR=1.69,95%CI为(1.12,2.55),P=0.010]、肿块内无钙化灶[OR=1.55,95%CI为(1.10,2.18),P=0.010]、雌激素受体(estrogen receptor,ER)阳性[OR=0.73,95%CI为(0.60,0.89),P=0.001]、孕激素受体(progesterone receptor,PR)阳性[OR=0.62,95%CI为(0.44,0.86),P=0.004]、肿块直径≤2 cm[OR=2.98,95%CI为(2.18,4.09),P<0.001]、核分级为低/中级别[OR=0.58,95%CI为(0.50,0.68),P<0.001]以及不可触及肿块[OR=0.48,95%CI为(0.28,0.82),P=0.008]的DCIS患者的穿刺病理学低估率更低。结论在DCIS患者中,患者年龄≥50岁、BI-RADS≤4A级、肿块直径≤2 cm、不可触及肿块、核分级较低(为低级别/中级别DCIS)、ER阳性、PR阳性、HER2阴性及无钙化灶可降低穿刺病理学低估率。受纳入研究数量和质量所限,以上结论尚需高质量大样本的队列研究结果证实。

Objective To systematically evaluate the related factors that lead to the underestimation of puncture pathology of ductal carcinoma in situ(DCIS),and to reduce the underestimation rate of puncture pathology of DCIS by controlling related factors.Methods A computer search of PubMed,Web of Science,The Cochrane Library,EMbase,CNKI,and Wanfang databases were conducted to retrieve clinical studies that led to underestimation of puncture pathology for DCIS between the establishment of the database and April 1,2021.After two researchers independently screened the literatures,extracted the data,and evaluated the risk of bias in the included studies,RevMan 5.4 software was used for meta analysis.Results A total of 24 studies including 8810 patients were included.Results of meta analysis showed that puncture pathology underestimation rate in patients≥50 years old was lower than that<50 years old[OR=0.82,95%CI(0.70,0.96),P=0.020].Breast imaging reporting and data system(BI-RADS)of DCIS≤4 A class patients had a lower puncture pathology underestimation rate[OR=0.38,95%CI(0.21,0.68),P=0.001].Human epidermal growth factorreceptor 2(HER2)negative[OR=1.69,95%CI(1.12,2.55),P=0.010],no calcification in the mass[OR=1.55,95%CI(1.10,2.18),P=0.010],estrogen receptor(ER)positive[OR=0.73,95%CI(0.60,0.89),P=0.001],progesterone receptor(PR)positive[OR=0.62,95%CI(0.44,0.86),P=0.004],tumor diameter≤2 cm[OR=2.98,95%CI(2.18,4.09),P<0.001],DCIS patients with low/intermediate nuclear grading[OR=0.58,95%CI(0.50,0.68),P<0.001],and untouchable masses[OR=0.48,95%CI(0.28,0.82),P=0.008]had lower puncture pathology underestimation rate.Conclusions In patients with DCIS,age≥50 years,BI-RADS≤4 A class,mass diameter≤2 cm,non-palpable mass,low nuclear grade(low grade/medium grade DCIS),ER positive,PR positive,HER2 negative,and no calcification can reduce the underestimation rate of puncture pathology.Due to the limitation of the number and quality of included studies,the above conclusions need to be confirmed by the results of high quality cohort studies with large samples.