造影增强超声内镜鉴别肿块型慢性胰腺炎与胰腺癌效果的Meta分析

目的系统分析造影增强超声内镜(CE-EUS)对肿块型慢性胰腺炎与胰腺癌的鉴别诊断价值。方法在中国知网、万方、中国生物医学文献数据库、Pubmed、Embase、cochrane library等数据库检索公开发表的采用CE-EUS鉴别诊断肿块型慢性胰腺炎与胰腺癌的中英文文献,检索期限截至2018年12月31日,对文献进行二次筛选、评分及数据提取,然后采用Meta-Disc1.4及stata12.0软件进行Meta分析。结果纳入20篇文献,共计1888例患者,CE-EUS对肿块型慢性胰腺炎与胰腺癌的鉴别诊断的汇总敏感度、特异度、阳性似然比、阴性似然比、诊断比值比分别为86%[95%可信区间(95%CI):83%~89%],93%(95%CI:92%~95%),12.01(95%CI:9.72~14.85),0.16(95%CI:0.10~0.26),76.12(95%CI:54.50~106.31),汇总受试者工作特征曲线下面积为0.9655。阈值效应检验、Meta回归分析及敏感性分析均未找到异质性来源。剔除引起异质性的4篇文献后,所有纳入文献异质性降至可接受范围内,Meta分析结果无明显变化。结论CE-EUS对肿块型慢性胰腺炎与胰腺癌具有良好的鉴别诊断价值,其在临床的普及应用可能提高胰腺癌的诊断率。

Value of contrast-enhanced endoscopic ultrasonography in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer:A Meta-analysis

Objective To systematically evaluate the value of contrast-enhanced endoscopic ultrasonography (CE-EUS) in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer.Methods CNKI,Wanfang Data,CBM,PubMed,Embase,and the Cochrane Library were searched for Chinese and English articles on the value of CE-EUC in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer published up to December 31,2018.Secondary screening,scoring,and data extraction were performed,and then Meta-Disc1.4 and stata12.0 software were used for meta-analysis.Results A total of 20 articles with 1888 patients were included in this study.The meta-analysis showed that in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer,CE-EUS had a pooled sensitivity of 86%(95% confidence interval [CI]: 83%-89%),a specificity of 93%(95%CI: 92%-95%),a positive likelihood ratio of 12.01 (95%CI: 9.72-14.85),a negative likelihood ratio of 0.16 (95%CI: 0.10-0.26),a diagnostic odds ratio of 76.12 (95%CI: 54.50-106.31),and an area under the summary receiver operating characteristic curve of 0.965 5.No sources of heterogeneity were found in the threshold effect test,the meta-regression analysis,and the sensitivity analysis.After the four articles causing heterogeneity were excluded,the heterogeneity of all included articles was reduced to an acceptable range,and there were no significant changes in the results of the meta-analysis.Conclusion CE-EUS has a good value in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer,and its application in clinical practice can improve the diagnostic rate of pancreatic cancer.