目的：系统评价当前研究PET/CT诊断宫颈癌盆腔及主动脉旁淋巴结转移文献的质量并合并分析其准确性。方法：收集当前研究PET/CT诊断宫颈癌盆腔及主动脉旁淋巴结转移的文献，并根据QUADAS（Quality assessment of diagnostic accuracy studies）质量评价标准评价符合纳入标准的文献的质量，用MetaDisc软件对敏感性、特异性等进行合并分析和异质性检验并绘制SROC曲线。结果：共纳入9篇符合纳入标准的文献，宫颈癌患者346例（3979例淋巴结转移）。以淋巴结为单位合并分析：敏感度为0.58 [95%可信区间（CI） 0.51~0.65]，特异度为0.98（95%CI 0.98~0.99），阳性预测值为0.686（0.464~0.852），阴性预测值为0.936（0.833~0.995），阳性似然比为21.5（7.20~64.24），阴性似然比为0.43（0.32~0.58），准确度为0.900（0.75~0.993），AUC值0.7724；以病人为单位合并分析：敏感度为0.54（95% CI 0.45~0.63），特异度为0.86（95%CI 0.98~0.99），阳性预测值为0.725（0.471~0.923），阴性预测值为0.765（0.615~0.886），阳性似然比为4.58（1.86~11.31），阴性似然比为0.52（0.34~0.80），准确度为0.756（0.620~0.0.897），AUC值0.8699。结论：PET/CT对宫颈癌盆腔及主动脉旁淋巴结转移具有中度诊断价值，可为制定治疗计划提供较为可靠的指导意见。
Abstract
Objective: To review studies focused on diagnosing pelvic and para-aortic lymph node metastasis in cervical cancer with PET/CT, analyse sources of bias and variability and evaluate the diagnostic accuracy with meta analysis. Methods: Searched current literature in database without limiting time and language, evaluated the quality of included studies according to QUADAS(Quality assessment of diagnostic accuracy studies), MetaDisc version 1.40 software was used to pool sensitivity, specificity, positive likelihood ratio(+LR), negative likelihood ratio(-LR) and diagnostic OR, analysed source of heterogeneity with Q-test and drew SROC curves. Results: Nine studies met the inclusion criteria, eight literatures written in English and one in Chinese. 346 cases of cervical cancer(3979 lymph node metastasis) were included, we pooled data with random effects model on lymph nodes level: sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy and AUC value were 0.58[95% confidence interval(CI) 0.51~0.65], 0.98 (95%CI 0.98~0.99), 0.686(0.464~0.852), 0.936(0.833~0.995), 2.15(7.20~64.24), 0.43(0.32~0.58), 0.900(0.75~0.993), 0.7724, respectively; pooled analysis with random effects model based on patient level: sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy and AUC value were 0.54(95%CI 0.45~0.63), 0.86(95%CI 0.98~0.99), 0.725(0.471~0.923), 0.765(0.615~0.886), 4.58(1.86~11.31), 0.52(0.34~0.80), 0.756(0.620~0.0.897) and 0.8699, respectively. Conclusion: PET/CT has moderate diagnostic value for evaluating pelvic and aortic lymph node metastasis in cervical cancer, which can provide reliable guidance in clincal practice．
关键词
宫颈肿瘤 /
淋巴转移 /
正电子发射断层显像术 /
体层摄影术 /
螺旋计算机
Key words
Cervix neoplasms /
Lymphatic metastasis /
Positron-emission tomography /
Tomography /
spiral computed
中图分类号：
Ｒ737.33
Ｒ817.4
R814.42
