Liao Li-Jen, Hsu Wan-Lun, Wang Chi-Te, Lo Wu-Chia, Lai Mei-Shu
Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Head Neck. 2016 Apr;38(4):628-34. doi: 10.1002/hed.23945. Epub 2015 Jun 26.
The purpose of this was to find a staging strategy sensitive enough to reduce the risk of occult metastases in cN0 head and neck cancer to below 15% to 20%.
A total of 73 articles were selected for analysis of the diagnostic performance in staging cN0 head and neck cancer. Hypothetical estimation of negative predictive value (NPV) was calculated based on the Bayesian theory.
The pooled estimates for sensitivity were 56.4% and 84.9% for ultrasound-guided fine-needle aspiration (FNA) and sentinel node biopsy (SNB). The pooled estimates for sensitivity were 47.0%, 56.6%, 48.3%, and 63.3% for CT, MRI, positron emission tomography (PET), and ultrasound, respectively. The pooled estimates for specificity were 88.9%, 82.5%, 86.2%, and 79.1% for CT, MRI, PET, and ultrasound. In estimation, the CT or MRI with SNB strategies had NPV higher than 85% even when the pretest metastatic rate was 60%.
The SNB procedure has the best performance. A combination of CT/MRI and SNB for cN0 head and neck cancer is preferred.
本研究的目的是找到一种足够敏感的分期策略，将cN0期头颈癌隐匿性转移的风险降低至15%至20%以下。
共选择73篇文章分析cN0期头颈癌分期的诊断性能。基于贝叶斯理论计算阴性预测值（NPV）的假设估计值。
超声引导下细针穿刺活检（FNA）和前哨淋巴结活检（SNB）的敏感性合并估计值分别为56.4%和84.9%。CT、MRI、正电子发射断层扫描（PET）和超声的敏感性合并估计值分别为47.0%、56.6%、48.3%和63.3%。CT、MRI、PET和超声的特异性合并估计值分别为88.9%、82.5%、86.2%和79.1%。在估计中，即使术前转移率为60%，采用SNB策略的CT或MRI的NPV也高于85%。
SNB程序性能最佳。对于cN0期头颈癌，首选CT/MRI与SNB联合使用。
