高频超声在亚洲女性中筛查乳腺癌 准确性的系统评价

目的 评价高频超声在亚洲女性中筛查乳腺癌的准确性及价值.方法 系统地收集高频超声筛查亚洲女性乳腺癌的研究文献;按照QUADAS工具对纳入文献进行质量评价;采用Meta-DiSc 1.4软件计算高频超声的合并灵敏度和特异度,绘制综合受试者工作特征(SROC)曲线;并计算高频超声筛查早期乳腺癌(包括TNM 0期、Ⅰ期和Ⅱ期)的构成比.结果 共纳入7篇筛查报告,研究对象22 244人.QUADAS质量评价结果表明:A级文献有5篇、B级文献有2篇,纳入文献质量较高.Meta分析结果显示,纳入的研究具有异质性(Q=38.97,P＜0.0001),利用随机效应模型(REM)估计合并值,合并灵敏度和特异度分别为0.785(95%CI:0.726～0.837)和0.975(95%CI:0.973～0.977),SROC曲线下面积(AUC)为0.9800.在随访超过一年的研究中,96.9%(63例)的患者处于临床Ⅱ期及之前.结论 纳入的7项研究显示高频超声在亚洲女性乳腺癌筛查中有较高的准确性,且有发现早期乳腺癌的能力.

Evaluation on the accuracy of high-frequency ultrasound being used in the breast cancer screening program in women from Asian countries; a systematic review

Objective To evaluate the accuracy and value of high-frequency ultrasound for breast cancer screening in Asian women. Methods Published studies on high-frequency ultrasound for screening breast cancer in Asian women were systemically searched and assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Meta-DiSc 1.4 software was used for extracting data, calculating the summary sensitivity and specificity, and drawing the Summary Receiver Operating Characteristic (SROC) curve. Furthermore, the proportion of screening of diagnosis on early breast cancer (TNM stage 0, Ⅰ and Ⅱ ) by high-frequency ultrasound was calculated. Results Seven screening studies including 22 244 women were selected for Metaanalysis. According to the QUADAS items, 5 studies were classified as A degree and 2 studies were evaluated as B degree. For study in the heterogeneous of these 7 studies (Q=38.97, P＜0.0001 ),Random Effects Model (REM) was selected. The combined sensitivity (95%CI) and specificity (95%CI) were 0.785 (0.726-0.837) and 0.975 (0.973-0.977) respectively. The Area Under the Curve (AUC) of SROC was 0.9800. Among the follow-up studies of following period over one year, 96.9%of the diagnosed patients with breast cancer were at clinical stage Ⅱ or prior to it. Conclusion Because of its high accuracy, high- frequency ultrasound could be recommended for screening breast cancer in Asian women.