Henschke Nicholas, Maher Christopher G, Refshauge Kathryn M
Back Pain Research Group, School of Physiotherapy, University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia.
Eur Spine J. 2007 Oct;16(10):1673-9. doi: 10.1007/s00586-007-0412-0. Epub 2007 Jun 14.
To describe the accuracy of clinical features and tests used to screen for malignancy in patients with low back pain. A systematic review was performed on all available records on MEDLINE, EMBASE, and CINAHL electronic databases. Studies were considered eligible if they investigated a cohort of low back pain patients, used an appropriate reference standard, and reported sufficient data on the diagnostic accuracy of tests. Two authors independently assessed methodological quality and extracted data to calculate positive (LR+) and negative (LR-) likelihood ratios. Six studies evaluating 22 different clinical features and tests were identified. The prevalence of malignancy ranged from 0.1 to 3.5%. A previous history of cancer (LR+ = 23.7), elevated ESR (LR+ = 18.0), reduced hematocrit (LR+ = 18.2), and overall clinician judgement (LR+ = 12.1) increased the probability of malignancy when present. A combination of age > or =50 years, a previous history of cancer, unexplained weight loss, and failure to improve after 1 month had a reported sensitivity of 100%. Overall, there was poor reporting of methodological quality items, and very few studies were performed in community primary care settings. Malignancy is rare as a cause of low back pain. The most useful features and tests are a previous history of cancer, elevated ESR, reduced hematocrit, and clinician judgement.
描述用于筛查腰痛患者恶性肿瘤的临床特征和检查的准确性。对MEDLINE、EMBASE和CINAHL电子数据库中的所有可用记录进行了系统评价。如果研究调查了一组腰痛患者，使用了适当的参考标准，并报告了关于检查诊断准确性的充分数据，则认为这些研究符合条件。两位作者独立评估方法学质量并提取数据以计算阳性（LR+）和阴性（LR-）似然比。确定了六项评估22种不同临床特征和检查的研究。恶性肿瘤的患病率为0.1%至3.5%。有癌症病史（LR+ = 23.7）、血沉升高（LR+ = 18.0）、血细胞比容降低（LR+ = 18.2）以及临床医生的总体判断（LR+ = 12.1）在存在时会增加恶性肿瘤的可能性。年龄≥50岁、有癌症病史、不明原因体重减轻以及1个月后无改善的组合报告的敏感性为100%。总体而言，方法学质量项目的报告较差，并且在社区初级保健环境中进行的研究很少。恶性肿瘤作为腰痛的病因很少见。最有用的特征和检查是有癌症病史、血沉升高、血细胞比容降低以及临床医生的判断。
