超声内镜引导下细针穿刺活检对胰腺实性占位定性诊断价值的Meta分析

目的:系统评价超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺实性占位定性诊断中的价值.方法:计算机检索MEDLINE、Cochrane Library、中国生物医学文献数据库、万方数据库、中国学术期刊全文等数据库,检索时间均为建库至2011-10.全面查找有关EUS-FNA诊断胰腺实性占位的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据QUADAS质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC).结果:共检索出相关文献280篇,按照文献纳入标准,最终纳入18篇文献(均为英文文献).EUS-FNA对胰腺实性占位定性诊断价值分别为:汇总敏感度为0.9095%CI(0.89-0.92)],汇总特异度为0.9595%CI(0.93-0.97)],汇总阳性似然比为13.5695%CI(8.31-22.15)],汇总阴性似然比为0.1295%CI(0.10-0.15)],汇总诊断优势比为143.6295%CI(93.98-219.46)],SROC曲线下面积AUC为0.9711,Q*=0.9215.另外,本研究还对有无病理医生在场指导进行了亚组分析,发现有病理医生在场的AUC为0.9757,Q*=0.9295.且汇总诊断优势比173.3795%CI(98.09-306.44)],明显较无病理医生在场的113.6495%CI(60.22-214.46)]高.结论:经SROC曲线证实,EUS-FNA活检在胰腺实性占位定性诊断中具有较高的灵敏度和特异度,尤其是有病理医生在场指导的情况下,可作为临床上胰腺实性占位定性诊断的重要检查手段.

Diagnostic value of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic masses: A meta-analysis

AIM: To establish the overall diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for solid pancreatic masses. METHODS: We searched PubMed (1966/2011-10), Cochrane Library (from establishment to 2011-10), CNKI (1994/2011-10), CBM (1978/2011-10) and Wanfang (2000/2011-10) databases to find all diagnostic tests about EUS-FNA for solid pancreatic masses. After collecting studies according to inclusion criteria of diagnostic tests, data (study background, design information and diagnostic parameters) were extracted. QUADAS items were used to evaluate the qualities of the included studies. Meta-disc software was used to handle data of included studies and to examine heterogeneity. The effectmodel was selected according to outcomes of heterogeneity. After all included studies were weighted and combined, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and their 95%CI were calculated, and SROC curve was drawn. RESULTS: A total of 280 potentially relevant studies were retrieved. According to eligibility criteria, 18 studies were included (all in English). The meta-analysis results are as follows: pooled sensitivity 0.90 (95%CI, 0.89-0.92), pooled specificity 0.95 (95%CI, 0.93-0.97), PLR 13.56 (95%CI, 8.31-22.15), NLR 0.12 (95%CI, 0.10-0.15), DOR 143.62 (95%CI, 93.98-219.46) and SROC AUC 0.9711 (Q* = 0.9215). Moreover, subgroup analysis was performed to identify the sources of heterogeneity according to the presence or absence of an on-site cytopathologist. The SROC AUC was 0.9757 (Q* = 0.9295) in the presence of an on-site cytopathologist. The DOR in the presence of an on-site cytopathologist was higher that in the absence of an on-site cytopathologist 173.37 (95%CI, 98.09-306.44) vs 113.64 (95%CI, 60.22-214.46)]. CONCLUSION: EUS-FNA has a high sensitivity and specificity in the diagnosis of solid pancreatic masses, especially in the presence of an on-site cytopathologist.