MRI评估宫颈癌淋巴结转移价值的系统评价

A Systematic Review of the Value of MRI in Evaluating Lymph Node Metastasis of Cervical Cancer

目的系统评价MRI对宫颈癌淋巴结转移的价值。方法计算机全面检索PubMed、The Cochrane Library、EMbase、中国知网(CNKI)、万方数据库(Wanfang Data)、维普数据库(VIP)和中国生物医学数据库(CBM),搜集MRI对宫颈癌淋巴结转移价值的相关研究,检索时限从建库至2021年9月。由两名研究者独立筛选文献、提取资料及数据,并使用QUADAS-2评价偏倚风险,采用Stata 16.0软件进行Meta分析,计算合并后的敏感度(Sen)、特异度(Spe)、阳性似然比(PLR)、阴性似然比(NLR)、诊断比值比(DOR)等性能指标,绘制森林图、集成受试者工作特征曲线(SROC曲线)并计算曲线下面积(AUC)。结果最终纳入21个诊断试验,共1549例宫颈癌患者。Meta分析结果显示Sen_(合并)为0.66,95%CI(0.51,0.78)、Spe_(合并)为0.86,95%CI(0.78,0.92)、PLR_(合并)为4.9,95%CI(2.6,9.0)、NLR_(合并)为0.40,95%CI(0.26,0.61)、DOR为12,95%CI(5,33)、AUC_(合并)为0.85,95%CI(0.81,0.88)。平扫+动态增强扫描的Sen及Spe最高,分别为Sen_(合并)为0.88,95%CI(0.78,0.94)、Spe_(合并)为0.92,95%CI(0.79,0.98)。平扫、平扫+常规增强扫描、平扫+动态增强扫描的AUC_(合并)分别为0.77,95%CI(0.74,0.81)、0.65,95%CI(0.61,0.69)、0.94,95%CI(0.91,0.95)。1.5 T的Sen略高于3.0 T,为Sen_(合并)为0.68,95%CI(0.47,0.83)、1.5 T及3.0 T Spe基本相同。1.5 T及3.0 T的AUC_(合并)分别为0.86,95%CI(0.83,0.89)、0.81,95%CI(0.78,0.85),两种检查方法的AUC_(合并)差异没有统计学意义(Z=1.819,P>0.05)。结论MRI评估宫颈癌淋巴结转移具有较好的诊断效能,其Spe较高。通过亚组分析得出,平扫联合动态增强扫描的诊断效能最高;而不同磁场强度的诊断价值无差异。

Objective To systematically evaluate the value of MRI in lymph node metastasis of cervical cancer.Methods Computer comprehensive search of PubMed,The Cochrane Library,EMbase,China National Knowledge Network(CNKI),WanFang Data,Weipu Database and China Biomedical Database(CBM),and collected relevant studies on the value of MRI in cervical cancer lymph node metastasis.The search time limit is from the establishment of the database to September 2021.Two researchers independently screened the literature,extracted data and data,and used QUADAS-2 to evaluate the risk of bias.Stata 16.0 software was used for Meta analysis to calculate the combined sensitivity(Sen)and specificity(Spe),positive likelihood ratio(PLR),negative likelihood ratio(NLR),diagnostic odds ratio(DOR)and other performance indicators,draw forest plots,receiver operating characteristic curves(summary receiver-operating characteristic curves,SROC curve)and calculate the area under the SROC curve(AUC).Results 21 diagnostic tests were included,with a total of 1549 patients with cervical cancer.Meta analysis results showed that Sen was merged into[0.66,95%CI(0.51,0.78)],Spe was merged into[0.86,95%CI(0.78,0.92)],and PLR was merged into[4.9,95%CI(2.6,9.0)],NLR was combined into[0.40,95%CI(0.26,0.61)],DOR was[12,95%CI(5,33)],and AUC is combined into[0.85,95%CI(0.81,0.88)].The sensitivity and specificity of plain scan+DCE-MRI were the highest,respectively,the combination of Sen was[0.88,95%CI(0.78,0.94)],and the combination of Spe was[0.92,95%CI(0.79,0.98)].The combined AUC of plain scan,plain scan+conventional enhancement,and plain scan+DCE-MRI were[0.77,95%CI(0.74,0.81)],[0.65,95%CI(0.61,0.69)],[0.94,95%,respectively CI(0.91,0.95)].The sensitivity of 1.5 T was slightly higher than that of 3.0 T,which was the combination of Sen with[0.68,95%CI(0.47,0.83)],and the specificity of 1.5 T and 3.0 T was basically the same.The combined AUC of 1.5 T and 3.0 T were[0.86,95%CI(0.83,0.89)]and[0.81,95%CI(0.78,0.85)],respectively.There was no statistically significant difference in the combined AUC of the two inspection methods(Z=1.819,P>0.05).Conclusion MRI has a good diagnostic performance in evaluating lymph node metastasis of cervical cancer,and its specificity is high.Through subgroup analysis,it is concluded that the diagnostic efficiency of unenhanced scanning combined with dynamic enhancement is the highest;there is no difference in the diagnostic value of different magnetic field strengths.