Li Chunjie, Men Yi, Yang Wenbin, Pan Jian, Sun Jun, Li Longjiang
Attending Physician and Lecturer, Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China.
PhD Candidate, Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China.
J Oral Maxillofac Surg. 2014 Aug;72(8):1601-15. doi: 10.1016/j.joms.2014.02.014. Epub 2014 Feb 16.
To detect the diagnostic efficacy of computed tomography (CT) in distinguishing mandibular invasion caused by head and neck cancer and to compare the accuracy of contrast-enhanced and plain CT in the diagnosis.
Studies designed as cohort studies that detected the diagnostic efficacy of CT on mandibular invasion (including bone cortex and bone marrow invasion) and mandibular medullary alone (bone marrow invasion) were included. The included studies were required to use the pathologic diagnosis as the reference standard and reported true-positive, false-positive, false-negative, true-positive, and related data. Thirteen databases were electronically and manually searched to retrieve any possible related studies. Two reviewers independently conducted the study inclusion, data extraction, and assessment of the quality of the included studies. Meta-diSc, version 1.4, and STATA, version 11.0, were used to conduct the meta-analysis.
A total of 30 studies with 1459 patients were included in the present study. Of those patients, 1,257 underwent CT and were accounted for in the meta-analysis. Of the included studies, 1 had a low risk and 6 had a high risk of bias; 23 studies had an unclear risk of bias. Meta-regression showed that the slight clinical heterogeneity did not influence the outcome (P > .10). The meta-analysis showed that CT for the diagnosis of mandibular invasion had a pooled sensitivity of 0.72, specificity of 0.90, positive likelihood ratio (+LR) of 5.33, negative likelihood ratio (-LR) of 0.36, diagnostic odds ratio (DOR) of 21.41, area under the curve (AUC) of 0.9022, and Q* (the value of the sensitivity or specificity when the sensitivity equals the specificity on the summary receiver operating characteristics curve) of 0.8336. The CT findings for mandibular medullar invasion had a sensitivity of 0.81, specificity of 0.85, +LR of 4.76, -LR of 0.24, DOR of 29.49, AUC of 0.9240, and Q* of 0.8580. No statistical significance was found in the sensitivity (P = .809), specificity (P = .27), AUC (P = .4296), and Q* (P = .4277) between the contrast-enhanced and plain CT scans.
The present clinical evidence has shown that CT had an acceptable diagnostic value in detecting mandibular invasion caused by head and neck cancer. The high specificity of CT predicted it would be helpful when it was used to confirm the clinical diagnosis of bone invasion. Contrast-enhanced and plain CT scans had a similar diagnostic efficacy.
检测计算机断层扫描（CT）在鉴别头颈部癌所致下颌骨侵犯方面的诊断效能，并比较增强CT和平扫CT在诊断中的准确性。
纳入设计为队列研究的、检测CT对下颌骨侵犯（包括骨皮质和骨髓侵犯）及单纯下颌骨骨髓侵犯（骨髓侵犯）诊断效能的研究。纳入的研究需以病理诊断作为参考标准，并报告真阳性、假阳性、假阴性、真阴性及相关数据。通过电子和手工检索13个数据库以获取任何可能相关的研究。两名研究者独立进行研究纳入、数据提取及对纳入研究质量的评估。使用Meta - DiSc 1.4版和STATA 11.0版进行荟萃分析。
本研究共纳入30项研究，涉及1459例患者。其中，1257例患者接受了CT检查并纳入荟萃分析。在纳入的研究中，1项研究偏倚风险低，6项研究偏倚风险高；23项研究偏倚风险不明确。Meta回归显示轻微的临床异质性不影响结果（P＞0.10）。荟萃分析显示，CT诊断下颌骨侵犯的合并敏感度为0.72，特异度为0.90，阳性似然比（+LR）为5.33，阴性似然比（-LR）为0.36，诊断比值比（DOR）为21.41，曲线下面积（AUC）为0.9022，以及Q*（在汇总接受者操作特征曲线上敏感度等于特异度时的敏感度或特异度值）为0.8336。CT诊断下颌骨骨髓侵犯的敏感度为0.81，特异度为0.85，+LR为4.76，-LR为0.24，DOR为29.49，AUC为0.9240，Q为0.8580。增强CT和平扫CT在敏感度（P = 0.809）、特异度（P = 0.27）、AUC（P = 0.4296）及Q（P = 0.4277）方面未发现统计学差异。
目前的临床证据表明，CT在检测头颈部癌所致下颌骨侵犯方面具有可接受的诊断价值。CT的高特异度预示其在用于确认骨侵犯的临床诊断时会有帮助。增强CT和平扫CT扫描具有相似的诊断效能。
