CT评估胰腺和壶腹周围癌区域外淋巴结病变的诊断准确性：一项系统评价和荟萃分析
Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: a systematic review and meta-analysis.
作者信息
Tseng Dorine S J, van Santvoort Hjalmar C, Fegrachi Samira, Besselink Marc G, Zuithoff Nicolaas P A, Borel Rinkes Inne H, van Leeuwen Maarten S, Molenaar I Quintus
机构信息
Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
出版信息
Surg Oncol. 2014 Dec;23(4):229-35. doi: 10.1016/j.suronc.2014.10.005. Epub 2014 Oct 31.
OBJECTIVES
Computed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer.
METHODS
We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data.
RESULTS
After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80-100% and 67-90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0-38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively.
CONCLUSIONS
CT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration.
目的
计算机断层扫描（CT）是评估胰腺和壶腹周围癌可切除性最广泛使用的方法。根治性切除的禁忌证之一是存在区域外淋巴结转移。本荟萃分析调查CT在评估胰腺和壶腹周围癌区域外淋巴结转移方面的准确性。
方法
我们根据PRISMA指南系统回顾了文献。纳入了关于接受胰十二指肠切除术患者区域外淋巴结CT评估的研究。提取了基线特征、CT检查和组织病理学结果的数据。计算了各个研究和汇总数据的诊断准确性、阳性预测值（PPV）、阴性预测值（NPV）、敏感性和特异性。
结果
筛选后，纳入了4项队列研究，报告了157例胰腺或壶腹周围癌患者的CT检查结果和组织病理学结果。总体而言，诊断准确性、特异性和NPV分别在63%至81%、80%-100%和67%-90%之间变化。然而，PPV和敏感性范围分别为0至100%和0-38%。汇总的敏感性、特异性、PPV和NPV分别为25%、86%、28%和84%。
结论
CT在评估胰腺和壶腹周围癌区域外淋巴结转移方面诊断准确性较低。因此，仅根据CT怀疑区域外淋巴结转移不应被视为探查的禁忌证。
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