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超声內镜引导下细针穿刺诊断实性胰腺肿瘤:一项Meta分析

发布日期:2014-1-29 12:40:27 文章来源:GIE 作者次数:1110
    超声內镜引导下细针穿刺诊断实性胰腺肿瘤:一项Meta分析

    背景

    尽管成像技术进步了,但实性胰腺病变术前诊断依然富有挑战性。尽管超声內镜(EUS)检查效果离不开操作者,但它是一种微创耐受性良好的技术。细针穿刺活检(FNA)的联用(超声內镜引导下细针穿刺活检)为细胞病理学分析提供样本,这是强于其它成像技术的一个主要优势。

    目的

    确定EUS-FNA诊断胰腺癌的准确性。

    设计

    这是所发表的评估超声內镜引导下细针穿刺活检(EUS-FNA)诊断能力的研究中的一项Meta分析。如果要使用一项至少6个月的确定性手术病理或临床随访的参考标准,那么有关研究由MEDLINE确定,进而被列入其中。

    主要测量指标

    使用测试准确性Meta分析软件分析所选定研究中的数据,结果提供了一个灵敏度,特异性,诊断比值比的汇总值与一条综合接受者工作特性曲线。病理学结果有不充分,良性,非典型或恶性之分。进行预定小组分析。

    结果

    本研究共包括了1997年至2009年发表的33个研究,共4984例患者。恶性细胞学诊断的综合灵敏度为85%95%置信区间[CI]84-86),综合特异性为98%95%CL0.97-0.99)。若测定真正肿瘤包括非典型和不确定的细胞学结果,那么上述灵敏度可增至91%95CI90-92),但特异性降为94%95CI93-96)。前瞻性多中心研究中EUS-FNA诊断准确性有所增强。

    局限性

    发表偏倚不是综合准确性的一个重要决定因素。

    结论

    这项Meta分析表明,EUS-FNA是一种高度精确的诊断测试实性胰腺肿瘤的手段,而且在计划实性胰腺病变检查方法时应该考虑采用它。

    缩写词:DOR,诊断比值比;EUS-FNA,超声內镜引导下的细针穿刺活检;I2,不一致值;STARD,诊断准确性报告标准;sROC,综合接受者工作特性。

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    EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis

    Background

    Preoperative diagnosis of solid pancreatic lesions remains challenging despite advancement in imaging technologies. EUS has the benefit of being a minimally invasive, well-tolerated procedure, although results are operator-dependent. The addition of FNA (EUS-guided FNA) provides samples for cytopathologic analysis, a major advantage over other imaging techniques.

    Objective

    To determine the diagnostic accuracy of EUS-FNA for pancreatic cancer.

    Design

    This is a meta-analysis of published studies assessing the diagnostic capability of EUS-FNA. Relevant studies were identified via MEDLINE and were included if they used a reference standard of definitive surgical histology or clinical follow-up of at least 6 months.

    Main Outcome Measurements

    Data from selected studies were analyzed by using test accuracy meta-analysis software, providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve. Cytology results were classified as inadequate, benign, atypical, suspicious, or malignant. Predefined subgroup analysis was performed.

    Results

    Thirty-three studies published between 1997 and 2009 were included, with a total number of 4984 patients. The pooled sensitivity for malignant cytology was 85% (95% confidence interval [CI], 84-86), and pooled specificity was 98% (95% CI, 0.97-0.99). If atypical and suspicious cytology results were included to determine true neoplasms, the sensitivity increased to 91% (95% CI, 90-92); however, the specificity was reduced to 94% (95% CI, 93-96). The diagnostic accuracy of EUS-FNA was enhanced in prospective, multicenter studies.

    Limitation

    Publication bias was not a significant determinant of pooled accuracy.

    Conclusion

    This meta-analysis demonstrates that EUS-FNA is a highly accurate diagnostic test for solid neoplasms of the pancreas and should be considered when algorithms for investigating solid pancreatic lesions are being planned.

    Abbreviations:  DOR, diagnostic odds ratio , EUS-FNA, EUS-guided FNA , I2, inconsistency value , STARD, Standards for the Reporting of Diagnostic Accuracy , sROC, summary receiver operating characteristic

     

     

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