胃超声检查对胃癌诊断价值的Meta分析

目的应用Meta分析方法评价口服造影剂胃超声检查诊断胃癌的准确性。 方法检索PubMed、Web of Science、万方资源数据库、中国期刊全文数据库（CNKI），收集2000年1月至2019年12月公开发表的胃超声检查诊断胃癌准确性的研究，根据文献纳入和排除标准筛选出符合条件的文章，并采用QUADAS-2量表对纳入的文献进行质量评价。运用R统计软件对以诊断准确性为结局指标的文献进行Meta分析，运用Stata 15软件对以四格表为结局的文献进行Meta分析。 结果最终纳入文献30篇，共3613例研究对象。胃超声检查诊断胃癌的准确性为94%（95%CI：92%~95%），其中对早期胃癌的诊断准确性为81% （95%CI：74%~87%）。Meta回归分析发现研究设计可能是诊断准确性结果的异质性来源，亚组分析后，前瞻性设计的研究文献诊断准确性为96%（95%CI：95%~97%）。根据文献检索策略，最终纳入研究的30篇文献中，5篇可提供完整的诊断四格表数据，共计纳入研究对象1675例，5篇文献合并敏感度为0.93（95%CI：0.89~0.95），特异度为0.98（95%CI：0.86~1.00），阳性似然比为37.19（95%CI：6.40~216.23），阴性似然比为0.07（95%CI：0.05~0.11），诊断优势比为507.18（95%CI：91.18~2821.10），综合受试者工作特征（SROC）曲线下面积为0.95（95%CI：0.92~0.96）。 结论通过Meta分析得出口服造影剂胃超声检查诊断胃癌的准确性较高，作为一种低成本、非侵入性诊断技术值得临床普及推广应用，并可对此开展健康人群胃癌初筛和风险评估研究。

Diagnostic value of oral contrast trans-abdominal ultrasonography for gastric cancer: a meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of oral contrast trans-abdominal ultrasonography (OCTU) for gastric cancer by performing a meta-analysis. MethodsResearch articles on the diagnosis of OCTU for gastric cancer published from January 2000 to December 2019 were comprehensively collected through searching PubMed, Web of Science, Wanfang Databases, and CNKI. The eligible articles were selected according to the inclusion and exclusion criteria. The QUADAS-2 scale was applied for methodology quality evaluation, R version 3.6.1 software was used to perform meta-analysis for diagnostic accuracy rate, and STATA 15 software was used to perform meta-analysis for the 2 × 2 table data. ResultsThirty articles consisting of 3613 patients were enrolled in this meta-analysis. The diagnostic accuracy of OCTU for gastric cancer and early gastric cancer was 94% (95%CI: 92%-95%) and 81% (95%CI: 74%-87%), respectively. Meta-regression analysis suggested that the research design might be a major heterogeneous source for accuracy rate. After subgroup analysis, the diagnostic accuracy for prospective studies was 96% (95%CI: 95%-97%). According to the searching criteria, 5 out of the 30 articles were finally included with complete data of the four-grid diagnostic table, including a total of 1675 subjects. The sensitivity of OCTU was 0.93 (95%CI: 0.89-0.95), specificity was 0.98 (95%CI: 0.86-1.00), positive likelihood ratio (LR +) was 37.19 (95%CI: 6.40-216.23), negative likelihood ratio (LR -) was 0.07 (95%CI: 0.05-0.11), and diagnostic advantage ratio (DOR) was 507.18 (95%CI: 91.18-2821.10). The area under the SROC (symmetric receiver operator characteristic curve) curve was 0.95 (95%CI: 0.92-0.96). ConclusionOur meta-analysis result indicated that OCTU is an accurate method for the diagnosis of gastric cancer. As a low-cost, non-invasive diagnostic technology, OCTU is recommended as a preliminary screening and risk stratification method for gastric cancer among asymptomatic populations.