EUS和MRCP对胆总管结石诊断准确性试验的Meta分析

目的通过Cochrane协作网推荐的头对头比较的诊断准确性试验(DTA)的Meta分析方法,系统评价和比较超声内镜(EUS)和磁共振胰胆管成像(MRCP)对胆总管结石的诊断价值。方法检索Ovid Medline、PubMed、EmBase、Cochrane Library、Clinical Trials和ISI Web of Knowledge数据库中建库至2019年1月有关EUS和MRCP对胆总管结石诊断价值的文献。公认的参考标准为经内镜逆行胰胆管造影(ERCP)、术中胆管造影(IOC)或阴性病例临床随访>3个月。使用QUADAS-2工具评价纳入研究的质量。采用RevMan 5.2、STATA 12和Meta-DiSc 1.4软件进行Meta分析,合并诊断效应量,绘制森林图和SROC曲线并计算曲线下面积(AUC),比较EUS和MRCP对胆总管结石的诊断效能。结果共纳入32项研究中的5项,累计病例272例。纳入的研究均未表现出高偏倚风险。随机效应模型合并统计显示,EUS诊断胆总管结石的灵敏度为0.97,特异度为0.90,阳性似然比为7.54,阴性似然比为0.07,诊断比值比(DOR)为162.55。MRCP诊断胆总管结石的灵敏度为0.87,特异度为0.92,阳性似然比为8.99,阴性似然比为0.19,DOR为79.02。EUS的合并DOR明显高于MRCP(P=0.008),进一步分析表明,这主要是由于EUS的灵敏度显著高于MRCP(P=0.006)。两种方式的特异度差异无统计学意义(P=0.42)。SROC曲线显示,EUS和MRCP的AUC分别为0.9771和0.9523,Q*统计量分别为0.9320和0.8936,但差异无统计学意义(P>0.05)。结论EUS和MRCP对胆总管结石均能提供良好的诊断准确性,但EUS具有更高的诊断准确性和灵敏度,且具有相当的特异度。在适当的情况下,EUS应被纳入胆总管结石疑似患者的诊断方式中。

Diagnostic test accuracy of EUS and MRCP in detecting choledocholithiasis: a Meta-analysis

Objective To evaluate and compare the diagnostic value of endoscopic ultrasonography(EUS)and magnetic resonance cholangiopancreatography(MRCP)for choledocholithiasis in a Meta-analysis of diagnostic test accuracy(DTA)using head-to-head comparison recommended by the Cochrane Collaboration.Methods The literatures about the diagnostic value of EUS and MRCP for choledocholithiasis were searched by Ovid Medline,PubMed,EmBase,Cochrane Library,Clinical Trials and ISI Web of Knowledge databases from the establishment of the databases to Jan.2019.The accepted reference standard were considered endoscopic retrograde cholangiopancreatography(ERCP),intraoperative cholangiography(IOC)or clinical follow-up>3 months for negative cases.Quality of the included studies was evaluated using QUADAS-2 tool.Meta-analysis was performed by RevMan 5.2,STATA 12 and Meta-DiSc 1.4 software.Sensitivity,specificity,likelihood ratio and diagnostic odds ratio(DOR)were pooled by random-effect model.The forest plots and SROC curves were developed and the area under the curve(AUC)was calculated.The diagnostic efficacy of EUS and MRCP for choledocholithiasis were compared.Results A total of 5 out of 32 studies were included,with a total of 272 cases.None of the included studies presented high risk of bias.The randomized effect model and statistics showed that the sensitivity of EUS in the diagnosis of choledocholithiasis was 0.97,the specificity was 0.90,the positive likelihood ratio was 7.54,the negative likelihood ratio was 0.07,and the DOR was 162.55.The sensitivity of MRCP was 0.87,the specificity was 0.92,the positive likelihood ratio was 8.99,the negative likelihood ratio was 0.19,and DOR was 79.02.The overall DOR of EUS was significantly higher than the one with MRCP(P=0.008).Further analysis showed that this was mainly due to the significantly higher sensitivity of EUS compared with the one with MRCP(P=0.006).The specificity was not significantly different between two modalities(P=0.42).The SROC curves showed that the AUC of EUS and MRCP were 0.9771 and 0.9523,and the Q*value were 0.9320 and 0.8936,respectively.There was no statistical significance between them(P>0.05).Conclusion Both EUS and MRCP provide good diagnostic accuracy for choledocholithiasis with EUS providing statically better diagnostic accuracy and sensitivity with comparable specificity.EUS should be incorporated in the diagnostic algorithm in patients suspected of choledocholithiasis whenever appropriate.