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对比增强型内镜超声检查对胰腺肿块病变的鉴别诊断:一项荟萃分析

发布日期:2014-1-29 12:40:48 文章来源:GIE 作者次数:1841
    20111217收到,2012222批准,2012618网上发布。

    背景

    采用目前的成像技术区分胰腺癌和其它胰腺肿块仍很困难。对比增强型内镜超声进一步改善了内镜超声检查的效果,从而使胰腺病变特征化。

    目的

    通过汇集现有实验数据,评估对比增强型内镜超声检查术对胰腺肿块患者腺癌诊断的准确性。

    设计

    我们对MedinePubMedWeb of ScienceEmbase Cochrane中心试验数据库进行了检索,以搜索所发表的相关研究。之后进行Meta分析。随后在一项固定效应模型或随机效应模型中进行了数据汇集。

    患者

    12项研究,共1139例患者。

    干预

    对比增强超声内镜

    主要测量指标

    荟萃分析和元回归分析。

    患者

    对比增强型内镜超声对胰腺癌的鉴别诊断的总敏感性为94%95%的置信区间为0.91-0.95),而且其特异性为89%95%的置信区间为0.85-0.92)。受试者工作特征曲线下面积为0.9732。合并的阳性似然比为8.0995%的置信区间为4.47-14.64),而阴性似然比为0.0895%的置信区间为0.06-0.10)。排除异常值后,亚组分析得出:对胰腺癌鉴别诊断的敏感性为93%95%的置信区间为0.91-0.95),特异性为93%95%的置信区间为0.89-0.95)。受试者工作特征曲线下面积为0.9745

    局限性

    较少的研究符合纳入标准。

    结论

    对患者胰腺肿块病变的患者来说,对比增强型内镜超声检查术是一项有发展潜力且可靠的鉴别诊断胰腺癌的手段。而且次增强型病变的发现结果是一种灵敏且准确的预测胰腺癌的因素。故在临床实践中,它似乎是一种有用的工具。

    缩写词:AUC。曲线下面积;Cl,置信区间;LR,概率比;QUADAS,所研究的诊断准确性质量评估;SROC,受试者工作特征曲线;UCAsUS造影剂。

     


    Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: a meta-analysis

    Received 17 December 2011; accepted 22 February 2012. published online 18 June 2012.

    Background

    Distinguishing pancreatic adenocarcinomas from other pancreatic masses remains challenging with current imaging techniques. Contrast-enhanced EUS further improved the efficacy of EUS to characterize pancreatic lesions.

    Objective

    To assess the accuracy of contrast-enhanced EUS for diagnosing adenocarcinoma in patients with pancreatic masses by pooling data of existing trials.

    Design

    We systematically searched the Medline, PubMed, Web of Science, Embase, and Cochrane Central Trials databases for relevant studies published. Meta-analysis was performed. Pooling was conducted in a fixed-effect model or a random-effects model.

    Patients

    Twelve studies involving 1139 patients were included.

    Intervention

    Contrast-enhanced EUS.

    Main Outcome Measurements

    Meta-analysis and meta-regression analysis.

    Results

    The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic adenocarcinomas was 94% (95% CI, 0.91-0.95), and the specificity was 89% (95% CI, 0.85-0.92). The area under the curve under summary receiver operating characteristic was 0.9732. The pooled positive likelihood ratio was 8.09 (95% CI, 4.47-14.64), and the negative likelihood ratio was 0.08 (95% CI, 0.06-0.10). The subgroup analysis by exclusion of the outliers provided a sensitivity of 93% (95% CI, 0.91-0.95) and a specificity of 93% (95% CI, 0.89-0.95) for the differential diagnosis of pancreatic adenocarcinomas. The area under the curve under summary receiver operating characteristic was 0.9745.

    Limitations

    A small number of studies met the inclusion criteria.

    Conclusion

    Contrast-enhanced EUS is a promising, reliable modality for the differential diagnosis of pancreatic adenocarcinoma in patients with pancreatic mass lesions. The finding of a hypoenhanced lesion was a sensitive and accurate predictor of pancreatic adenocarcinomas. It seems to be a useful tool in clinical practice.

    Abbreviations:  AUC, area under the curve, CI, confidence interval, LR, likelihood ratio, QUADAS, quality assessment of diagnostic accuracy studied, SROC, summary receiver operating characteristic, UCAs, US contrast agents

     

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