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中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (06) : 506 -513. doi: 10.3877/cma.j.issn.1674-0793.2013.06.021

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循证医学

内镜超声引导下细针穿刺抽吸活检诊断胰腺黏液性病变的系统回顾及Meta分析
  1. 1. 510080 广州,中山大学附属第一医院肝胆外科
  • 收稿日期:2013-10-31 出版日期:2013-12-01
  • Received:2013-10-31 Published:2013-12-01
引用本文:

. 内镜超声引导下细针穿刺抽吸活检诊断胰腺黏液性病变的系统回顾及Meta分析[J/OL]. 中华普通外科学文献(电子版), 2013, 07(06): 506-513.

背景

目前术前明确诊断胰腺囊性病变(PCLs)的良恶性难度仍然较大,绝大多数非黏液囊性病变(NMCLs)为良性病变,而黏液囊性病变(MCLs)则具有潜在的恶性倾向,因此术前明确诊断恶性胰腺囊性病变具有重要的临床意义。

目的

本系统回顾及Meta分析比较了内镜超声引导下细针穿刺抽吸(EUS-FNA)活检在诊断MCLs和NMCLs中的敏感性、特异性、阳性预测值及阴性预测值(LRs)等指标。

方法

选择MEDLINE、SCOPUS、Cochrane及"CINAHL Plus"等数据库中的相关研究进行分析,将EUS-FNA活检结果与手术活检及手术切除病检结果进行比较分析。绘制累积敏感度、特异度和预测值DerSimonian-Laird随机效应模型及总ROC曲线进行评价。

结果

11项对EUS-FNA活检结果、手术活检及手术切除病检结果的相关研究进入本系统回顾及Meta分析。MCLs的累积敏感度和特异度分别为0.63(95% CI:0.56~0.70)和0.88(95% CI:0.83~0.93),阳性预测值和阴性预测值分别为4.46(95% CI:1.21~16.43)和0.46(95% CI:0.25~0.86),总曲线下面积为0.89。

结论

内镜超声引导下细针穿刺抽吸活检诊断胰腺黏液囊性病变敏感度较低,但特异度高。如何提高敏感度有待进一步研究。

表1 被纳入的11项研究详细信息[例]
表2 黏液囊肿类型[例]
图1 本系统回顾和Meta分析筛选流程
图2 内镜超声引导下细针穿刺抽吸活检诊断胰腺黏液囊性病变的累积敏感度和特异度森林图。圆圈大小与各项研究样本量成比例,水平直线穿过圆圈代表该研究的95%置信区间。综合分析时,方块及垂直框代表累积敏感度或者特异度,垂直框的左右端为累积95%置信区间。注:sensitivity:敏感度,pooled sensitivity:累积敏感度,specificity:特异度,pooled specificity:累积特异度
图3 累积阳性预测值和阴性预测值森林图。圆圈大小与各项研究样本量成比例,水平直线穿过圆圈代表该研究的95%置信区间。综合分析时,方块及垂直框代表累积阳性预测值或阴性预测值,垂直框的左右端为累积95%置信区间。注:positive LR:阳性预测值,pooled positive LR:阳性预测值,negative LR:阴性预测值,pooled negative LR:累积阴性预测值,random effects model:随机效应模型
图4 所有前瞻性研究的累积敏感度和特异度森林图。圆圈大小与各项研究样本量成比例,水平直线穿过圆圈代表该研究的95%置信区间。综合分析时,方块及垂直框代表累积敏感度或者特异度,垂直框的左右端为累积95%置信区间。
图5 所有前瞻性眼睛的累积阳性预测值和阴性预测值森林图。圆圈大小与各项研究样本量成比例,水平直线穿过圆圈代表该研究的95%置信区间。综合分析时,方块及垂直框代表累积阳性预测值或阴性预测值,垂直框的左右端为累积95%置信区间。
图6 Meta分析的11项研究的总ROC曲线和4项前瞻性研究的总ROC曲线注:SROC Curve:总ROC曲线,symmetric SROC:对称性总ROC曲线,AUC:曲线下面积
表3 11项研究及其中4项前瞻性研究异质性因素的Meta回归分析
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