Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical College, No. 2 Fuxue Lane, Wenzhou 325000, China.
Eur J Radiol. 2012 Oct;81(10):2576-84. doi: 10.1016/j.ejrad.2011.10.026. Epub 2011 Dec 3.
Real-time elastography (RTE), as a non-invasive method, is used for the classification of benign and malignant lymph nodes (LNs) and developed as an alternative to biopsy. Elasticity score (ES) and strain ratio (SR) are used for the interpretation of RTE. We studied the performance of RTE for diagnosis of malignant LNs using meta-analysis.
PubMed, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure were searched. The studies published in English or Chinese relating to the diagnostic value of RTE for superficial LNs were collected. Hierarchical summary receiver operating characteristic (HSROC) curve was used to examine the RTE accuracy. Clinical utility of RTE for LNs was evaluated by Fagan plot analysis.
A total of 9 studies which included 835 LNs were analyzed. The summary sensitivity and specificity for the diagnosis of malignant LNs were 0.74 (95% confidence interval (CI), 0.66-0.81) and 0.90 (95% CI, 0.82-0.94) for ES, and 0.88 (95% CI, 0.79-0.93) and 0.81 (95% CI, 0.49-0.95) for SR, respectively. Compared to ES, SR obviously improved the diagnostic sensitivity value. The HSROCs were 0.88 for ES and 0.91 for SR, respectively. After RTE results over the cut-off value for malignant LNs ("positive" result), the corresponding post-test probability for the presence (if pre-test probability was 50%) was 88% for ES and 82% for SR, respectively; while, in "negative" measurement, the post-test probability was 22% and 13%, respectively.
RTE has a high accuracy in the classification of superficial LNs and can potentially help to select suspicious LNs for biopsy.
实时弹性成像（RTE）作为一种非侵入性方法，用于良性和恶性淋巴结（LNs）的分类，并被开发为活检的替代方法。弹性评分（ES）和应变比（SR）用于解释 RTE。我们通过荟萃分析研究 RTE 对恶性 LNs 诊断的性能。
检索PubMed、Cochrane 图书馆、ISI Web of Knowledge、中国国家知识基础设施，收集关于 RTE 对浅表 LNs 诊断价值的英文或中文研究。使用分层汇总受试者工作特征（HSROC）曲线检查 RTE 准确性。通过 Fagan 图分析评估 RTE 对 LNs 的临床实用性。
共分析了 9 项研究，共包括 835 个 LNs。ES 诊断恶性 LNs 的汇总敏感性和特异性分别为 0.74（95%置信区间[CI]，0.66-0.81）和 0.90（95%CI，0.82-0.94），SR 分别为 0.88（95%CI，0.79-0.93）和 0.81（95%CI，0.49-0.95）。与 ES 相比，SR 明显提高了诊断敏感性值。HSROCs 分别为 ES 的 0.88 和 SR 的 0.91。在 RTE 结果超过恶性 LNs 的截止值（“阳性”结果）后，对于存在（如果预测试概率为 50%）的相应后测试概率分别为 ES 的 88%和 SR 的 82%；而在“阴性”测量中，后测试概率分别为 22%和 13%。
RTE 对浅表 LNs 的分类具有较高的准确性，可能有助于选择可疑的 LNs 进行活检。
