18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者的诊断效能:Meta分析

目的 系统评价18F-氟脱氧葡萄糖（FDG）PET/CT对甲状腺球蛋白（Tg）表达阳性（简称Tg阳性）且131I全身显像（WBS）结果阴性（简称131I-WBS阴性）的分化型甲状腺癌（DTC）复发患者的诊断效能。 方法 检索PubMed、Embase、Cochrane Library和万方数据知识服务平台、中国知网、维普数据库、中国生物医学文献数据库中关于18F-FDG PET/CT对DTC复发患者诊断的相关研究，检索时间从建库至2020年12月。根据纳入和排除标准筛选文献，提取研究的基本特征和诊断参数，采用Spearman相关系数分析文献是否存在阈值效应，对纳入文献进行异质性Q检验，采用Deeks线性回归分析法评价文献的发表偏倚。绘制综合受试者工作特征（SROC）曲线，计算曲线下面积（AUC），采用Z检验分析行诊断性全身显像（Dx-WBS）与治疗性全身显像（Rx-WBS）的患者18F-FDG PET/CT诊断效能的差异，并分析在促甲状腺激素（TSH）刺激状态与抑制状态下18F-FDG PET/CT诊断效能的差异。 结果 最终纳入16篇文献，共1 036例DTC复发患者，纳入研究的异质性较低（I2=47.5%，P=0.018），异质性可能源于病例数（r=1.462，P=0.021），存在较小的发表偏倚（P=0.070）。18F-FDG PET/CT诊断Tg阳性且131I-WBS阴性的DTC复发患者的合并灵敏度为0.87（95%CI:0.82~0.91）、特异度为0.79（95%CI:0.68~0.86）、阳性似然比为3.76（95%CI:2.32~6.09）、阴性似然比为0.20（95%CI:0.14~0.27）、诊断优势比为23.89（95%CI:13.23~43.12）、SROC的AUC=0.91（标准误0.02）、Q指数为0.837（标准误0.023）。行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异无统计学意义（Z=0.041，P>0.05）。在TSH刺激状态与抑制状态下，行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异均无统计学意义（Z=1.864、0.525，均P>0.05）。 结论 18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者具有较高的诊断效能，行Dx-WBS与Rx-WBS、在TSH刺激状态与抑制状态下患者18F-FDG PET/CT的诊断效能均相当。

Diagnostic efficacy of 18F-FDG PET/CT in thyroglobulin-positive and 131I whole body imaging-negative differentiated thyroid cancer recurrence patients: a meta-analysis

Objective To systematically evaluate the diagnostic efficacy of 18F-fluorodeoxyglucose (FDG) PET/CT in differentiated thyroid cancer (DTC) recurrence patients with positive expression for thyroglobulin (Tg) (referred as Tg-positive) and negative result for 131I whole body imaging (WBS) (referred as 131I-WBS-negative). Methods PubMed, Embase, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Internet, VIP Database, and China Biomedical Literature Database were searched for relevant studies on the diagnosis of DTC recurrence by 18F-FDG PET/CT. The search time was from database establishment to December 2020. The literature was screened according to the inclusion and exclusion criteria, the basic characteristics and diagnostic parameters of the studies were extracted. Spearman correlation coefficient was used to analyze whether there was a threshold effect in the literature. Heterogeneity Q test was performed for the included literature, and Deeks linear regression analysis was used to evaluate the publication bias of the literature. The summary receiver operetor characteristic (SROC) curve was drawn, the area under the curve (AUC) was calculated, and the Z test was used to analyze the difference in the diagnostic performance of 18F-FDG in patients undergoing diagnostic whole-body imaging (Dx-WBS) and therapeutic imaging (Rx-WBS). The differences in the diagnostic performance of 18F-FDG PET/CT between thyroid-stimulating hormone (TSH)-stimulated and suppressed states were also analyzed. Results Finally, 16 articles were included, with a total of 1 036 patients with DTC recurrence. The heterogeneity of the included studies was low (I2=47.5%, P=0.018), which may be due to the number of cases (r=1.462, P=0.021), and there was a small publication bias (P=0.070). The combined sensitivity of 18F-FDG PET/CT in diagnosing Tg-positive and 131I-WBS-negative DTC recurrence patients was 0.87(95%CI: 0.82?0.91), the specificity was 0.79(95%CI: 0.68?0.86), and the positive likelihood ratio was 3.76(95%CI: 2.32?6.09), the negative likelihood ratio was 0.20(95%CI: 0.14?0.27), the diagnostic odds ratio was 23.89(95%CI: 13.23?43.12), and the AUC of SROC=0.905 (standard error of 0.022) and Q-index was 0.837 (standard error of 0.023). There was no significant difference in the diagnostic performance of 18F-FDG PET/CT between patients undergoing Dx-WBS and Rx-WBS (Z=0.041, P>0.05); there was no significant difference in the diagnostic performance of 18F-FDG PET/CT between TSH-stimulated and suppressed states undergoing Dx-WBS and Rx-WBS (Z=1.864, 0.525; both P>0.05). Conclusions 18F-FDG PET/CT has high diagnostic efficacy for Tg-positive and 131I-WBS-negative DTC recurrence patients. The diagnostic efficacy of 18F-FDG PET/CT in patients undergoing Dx-WBS and Rx-WBS, in TSH-stimulated and suppressed states is similar.