磁共振成像对直肠癌术前放化疗后再分期准确性的Meta分析

目的评价磁共振成像（MRI）对直肠癌术前放化疗后再分期的准确性。方法利用PubMed、EMBASE、Ovid和wok数据库，全面检索MRI对直肠癌术前放化疗后再分期相关的英文文献，检索日期1985年1月至2012年3月。对MRI用以直肠癌术前放化疗后再分期的敏感性和特异性进行Meta分析。结果最终纳入15篇，共749例患者。MRI对直肠癌术前放化疗后T3～T4分期诊断的敏感性为82．1％（95％CI：67．9％～90．9％），特异性为53．5％（95％CI：39．3％．67.3％），诊断比数比（DOR）为5．34（95％C1：2．73～10．45）；对阳性淋巴结诊断的敏感性、特异性及DOR分别为61．8％（95％CI：50．7％～71．8％）、72．0％（95％CI：61．3％～80．7％）和4．33（95％CI：2．84～6．59）；对环周切缘阳性诊断的敏感性、特异性及DOR分别为85．4％（95％CI：60．5％～95．7％）、80．0％（95％CI：57．4％～92．2％）和27．62（95％CI：13．03～58．55）。结论MRI对于直肠癌术前放化疗后B～T4和阳性淋巴结诊断准确性一般，而对环周切缘诊断准确性高。推荐术前常规利用MRI对直肠癌患者进行放化疗后再分期，以避免过度治疗。

Meta-analysis of diagnostic accuracy of magnetic resonance in restaging of rectal cancer after preoperative chemoradiotherapy

Objective To estimate the diagnostic accuracy of magnetic resonance （MR） in restaging of rectal cancer after preoperative chemoradiotherapy （CRT）. Methods Comprehensive search of literature concerning the diagnosis of MR for rectal cancer after preoperative CRT was performed from databases of PubMed, EMbase, OVID and WOK. Sensitivity and specificity of MR on restaging of rectal cancer after preoperative CRT were investigated by SAS and MetaDiSc software. Results Thirteen articles including 749 patients were enrolled in this meta-analysis. For T3-T4 stage, sensitivity of MR was 82.1%（95%CI： 67.9%-90.9%）, specificity was 53.5%（95%CI： 39.3%-67.3%）, and diagnostic odds ratio （DOR） was 5.34 （2.73, 6.59）. For lymph node involvement, sensitivity of MR was 61.8% （95%CI： 50.7%-71.8%）, specificity was 72.0%（95%CI： 61.3%-80.7%）, and DOR was 4.33 （95%C1： 2.84-6.59）. For circumferential resection margin （CRM） by MR, pooled sensitivity was 85.4% （95 % CI： 60.5%-95.7%）, specificity was 80.0%（95%C1： 57.4%-92.3%）, and DOR was 27.62 （95%CI： 13.03- 58.55）. Conclusions Restaging accuracy of T3-T4 and lymph nodes involvement of rectal cancer after preoperative CRT by MR is not high. MR may be a good method to make reassessment of CRM. To avoid overtreatment for T0-T2, negative lymph node and circumferential resection of rectal cancer, restaging by MR after preoperative CRT is important.