DWI对乳腺良恶性病变鉴别的循证诊断:Meta分析

目的:采用Meta分析方法综合定量评价DWI对乳腺良恶性病变的鉴别诊断价值。方法:检索Medline、Cochrane图书馆、中国生物医学文献数据库和中文科技期刊全文数据库等数据库中2008年1月²011年12月公开发表的中英文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究的特征信息。采用QUADAS条目评价纳入研究的方法学质量,采用Stata 11.0软件进行Meta分析,绘制汇总受试者工作特征曲线(summary receiver operating characteristic curve,SROC曲线),计算曲线下面积(area under curve,AUC)。结果:共纳入文献7篇,研究病灶共503个,QUADAS评价良好。DWI诊断乳腺病变良恶性的敏感度范围为58%2011年12月公开发表的中英文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究的特征信息。采用QUADAS条目评价纳入研究的方法学质量,采用Stata 11.0软件进行Meta分析,绘制汇总受试者工作特征曲线(summary receiver operating characteristic curve,SROC曲线),计算曲线下面积(area under curve,AUC)。结果:共纳入文献7篇,研究病灶共503个,QUADAS评价良好。DWI诊断乳腺病变良恶性的敏感度范围为58%⁹9%,特异度范围为52%99%,特异度范围为52%⁹7%。纳入文献具有同质性,按照固定效应模型计算出的汇总加权敏感度和特异度及95%可信区间分别为88%(81%97%。纳入文献具有同质性,按照固定效应模型计算出的汇总加权敏感度和特异度及95%可信区间分别为88%(81%⁹2%)、85%(78%92%)、85%(78%⁹0%);SROC曲线的AUC为0.92(0.8990%);SROC曲线的AUC为0.92(0.89⁰.94)。敏感度分析显示纳入文献稳定性好。结论:ADC值测量有助于乳腺病变的良恶性鉴别,但是良恶性ADC值范围有重叠,其实际临床应用价值有待进一步证实。

DWI in the differential diagnosis of benign versus malignant breast lesions： A meta-analysis

Objective： To evaluate the value of DWI in the differential diagnosis of benign and malignant breast lesions with rec- ta-analysis. Methods：Articles published in Chinese and English from 2008 to 2011 were searched in Medline,Cochrane library, Ovid and Chinese National Knowledge Internet （CNKI） according to the inclusion criteria for diagnostic research recommended by Cochrane Method Group. The characteristics of selected articles including the study background, design, results and diagnos- tic indicators were analyzed. Statistical analysis was performed by Stata software （Version 11） ;and the area under curve （AUC） of SROC was calculated. Results： Seven researches were included with a total of 503 lesions. The sensitivity and specificity of DWI for breast lesions ranged from 58% to 99 % and from 52%to 97 % respectively. All groups had homogeneity,and a fixa- tion effects regression was developed. The pooled weighted sensitivity and specificity with 95 % CI were 88% （81% - 92 % ） and 85 % （78 %-90 %） ;and the AUC of SROC curve were 0.92 （0.89- 0.94）. Sensitivity analysis showed no remarkable change on heterogeneity. Conclusion：The value of ADC in DWI can help to differentiate the benign breast lesions from the malignant with good sensitivity and specificity. But the values between benign and malignant lesions overlap. Further study is needed for the clinical application.