^(18)FDG-PET与CT诊断非小细胞肺癌纵隔淋巴结转移的对比研究——一项基于SROC的1999-2002年文献的Meta分析

A comparative study of ^(18)FDG-PET and CT on diagnosing mediastinal lymph nodes in non-small cell lung cancer--an SROC-based meta-analysis for literature published between 1999 and 2002

目的 用Meta分析(meta-analysis)的方法比较18FDG-PET与CT诊断非小细胞肺癌纵隔淋巴结转移的作用。材料与方法 收集1999-2002年国内外公开发表的18FDG-PET和/或CT诊断非小细胞肺癌纵隔淋巴结转移的文献,按Meta分析的要求和诊断试验公认的质量标准对所有符合条件的原始研究进行质量评估。以汇总的方法计算出18FDG-PET和CT的敏感性和特异性,以诊断试验Meta分析特有的SROC分析方法定性和定量地比较两者的准确性。结果 符合纳入标准的共12篇文献,其中10个18FDG-PET研究(769例患者),9个CT研究(1 408例患者);完全对比的18FDG-PET研究和CT研究各7个。汇总的诊断指标和SROC分析均显示18FDG-PET诊断非小细胞肺癌纵隔淋巴结转移的准确性明显高于CT,P<0.001。18FDG-PET和CT总的敏感性分别为0.85(95％CI 0.75-0.94)和0.47(95％CI 0.36-0.58);总的特异性分别为0.92(95％CI 0.87-0.96)和0.83(95％CI 0.79-0.87)。加权的最小二乘同归法显示18FDG-PET和CT的准确性分别是0.88±0.03和0.68±0.03,P<0.001。18FDG-PET和CT的对数优势比分别是4.01±0.54(95％CI 2.78-5.23)和1.47±0.30(95％CI 0.80-2.14),P<0.001。在18FDG-PET与CT不完全对比和完全对比两种情况下,结果是相似的。结论

Objective To meta-analytically compare 2-[fluorine 18]-2-deoxy-D-glucose positron emission tomography ('FDG-PET) and computed tomography (CT) for the diagnosis of mediastinal lymph nodes in patients with non-small cell lung cancer. Materials and Methods Evaluate all the sdudies that have been searched and adopt eligible studies of I8FDG-PET and/or CT. Calculate the pooled sensitivities and specificities of 18FDG-PET and CT. Compare the accuracies of 'FDG-PET and CT qualitatively and quantitatively using the method of SROC (summary receiver operating characteristic curves). Results Totally 10 studies of 18FDG-PET(769 patients) and 9 studies of CT(1 408 patients) were analysed. The pooled indexes of diagnostic performance and SROC indicated that 18FDG-PET was more accurate than CT for diagnosing mediaslinal lymph nodes. P<0.001. The pooled sensitivity and specificity were 0.85(95%CI 0.75-0.94) and 0.92(95%CI 0.87-0.96), respectively, for 18FDG-PET and 0.47(95%CI 0.36-0.58) and 0.83(95%CI 0.79-0.87), respectively, for CT. A weighted least-square regression indicated that the accuracies were 0.88?.03 for 18FDG-PET and 0.68?.03 for CT respectively,P<0.001. The log odds radios(±standard error)were 4.01±0.54(95%CI 2.78-5.23) for 18FDG-PET and 1.47±0.30(95%CI 0.80-2.14) for CT respectively, P<0.001. Conclusion 18FDG-PET is significantly more accurate than CT for diagnosis of mediastinal lymph nodes in patients with non-small cell lung cancer. Whether these enrolled studies are comparative or not, the conclusion is the same.