Division of Gynaecologic Oncology, Princess Margaret Hospital, University Health Network, Department of Obstetrics and Gynaecology, Toronto ON, Canada.
Gynecol Oncol. 2012 Jul;126(1):157-66. doi: 10.1016/j.ygyno.2012.03.048. Epub 2012 Apr 6.
To systematically review the existing literature in order to determine the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer.
A review of all systematic reviews and guidelines published between 1999 and 2009 was conducted as a first step. After the identification of a 2004 AHRQ systematic review on the topic, searches of MEDLINE for studies published since 2004 was also conducted to update and supplement the evidentiary base. A bivariate, random-effects meta-regression model was used to produce summary estimates of sensitivity and specificity and to plot summary ROC curves with 95% confidence regions.
Four meta-analyses and 53 primary studies were included in this review. The diagnostic performance of each technology was compared and contrasted based on the summary data on sensitivity and specificity obtained from the meta-analysis. Results suggest that 3D ultrasonography has both a higher sensitivity and specificity when compared to 2D ultrasound. Established morphological scoring systems also performed with respectable sensitivity and specificity, each with equivalent diagnostic competence. Explicit scoring systems did not perform as well as other diagnostic testing methods. Assessment of an adnexal mass by colour Doppler technology was neither as sensitive nor as specific as simple ultrasonography. Of the three imaging modalities considered, MRI appeared to perform the best, although results were not statistically different from CT. PET did not perform as well as either MRI or CT. The measurement of the CA-125 tumour marker appears to be less reliable than do other available assessment methods.
The best available evidence was collected and included in this rigorous systematic review and meta-analysis. The abundant evidentiary base provided the context and direction for the diagnosis of early-staged ovarian cancer.
系统地回顾现有文献，以确定术前识别疑似卵巢癌附件肿块的最佳策略。
首先对 1999 年至 2009 年间发表的所有系统评价和指南进行了回顾。在确定了 2004 年 AHRQ 对该主题的系统评价后，还对 2004 年后发表的研究进行了 MEDLINE 搜索，以更新和补充证据基础。使用双变量、随机效应荟萃回归模型生成敏感性和特异性的汇总估计值，并绘制具有 95%置信区间的汇总 ROC 曲线。
本次综述共纳入 4 项荟萃分析和 53 项原始研究。根据荟萃分析中获得的敏感性和特异性汇总数据，比较和对比了每种技术的诊断性能。结果表明，与二维超声相比，三维超声具有更高的敏感性和特异性。已建立的形态学评分系统也具有相当的敏感性和特异性，每种方法的诊断能力均相当。明确的评分系统的表现不如其他诊断测试方法。彩色多普勒技术评估附件肿块的敏感性和特异性均不如单纯超声。在考虑的三种成像方式中，MRI 似乎表现最好，尽管结果与 CT 无统计学差异。与 MRI 或 CT 相比，PET 的表现不如后者。CA-125 肿瘤标志物的测量似乎不如其他可用的评估方法可靠。
本次严格的系统评价和荟萃分析收集了最佳可用证据。丰富的证据基础为早期卵巢癌的诊断提供了背景和方向。
