Wang Xin, Wang Xiang Jiang, Song Hui Sheng, Chen Long Hua
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
Med Oncol. 2015 May;32(5):160. doi: 10.1007/s12032-015-0603-1. Epub 2015 Apr 21.
The aim of this study was to evaluate the diagnostic performance of the use of total choline signal-to-noise ratio (tCho SNR) criteria in MRS studies for benign/malignant discrimination of focal breast lesions. We conducted (1) a meta-analysis based on 10 studies including 480 malignant breast lesions and 312 benign breast lesions and (2) a subgroup meta-analysis of tCho SNR ≥ 2 as cutoff for malignancy based on 7 studies including 371 malignant breast lesions and 239 benign breast lesions. (1) The pooled sensitivity and specificity of proton MRS with tCho SNR were 0.74 (95 % CI 0.69-0.77) and 0.76 (95 % CI 0.71-0.81), respectively. The PLR and NLR were 3.67 (95 % CI 2.30-5.83) and 0.25 (95 % CI 0.14-0.42), respectively. From the fitted SROC, the AUC and Q* index were 0.89 and 0.82. Publication bias was present (t = 2.46, P = 0.039). (2) Meta-regression analysis suggested that neither threshold effect nor evaluated covariates including strength of field, pulse sequence, TR and TE were sources of heterogeneity (all P value >0.05). (3) Subgroup meta-analysis: The pooled sensitivity and specificity were 0.79 and 0.72, respectively. The PLR and NLR were 3.49 and 0.20, respectively. The AUC and Q* index were 0.92 and 0.85. The use of tCho SNR criteria in MRS studies was helpful for differentiation between malignant and benign breast lesions. However, pooled diagnostic measures might be overestimated due to publication bias. A tCho SNR ≥ 2 as cutoff for malignancy resulted in higher diagnostic accuracy.
本研究的目的是评估磁共振波谱（MRS）研究中使用总胆碱信噪比（tCho SNR）标准对乳腺局灶性病变进行良恶性鉴别的诊断性能。我们进行了：（1）一项基于10项研究的荟萃分析，其中包括480例恶性乳腺病变和312例良性乳腺病变；（2）一项基于7项研究的亚组荟萃分析，这些研究将tCho SNR≥2作为恶性肿瘤的截断值，其中包括371例恶性乳腺病变和239例良性乳腺病变。（1）质子MRS以tCho SNR作为指标时，合并敏感度和特异度分别为0.74（95%CI 0.69 - 0.77）和0.76（95%CI 0.71 - 0.81）。阳性似然比（PLR）和阴性似然比（NLR）分别为3.67（95%CI 2.30 - 5.83）和0.25（95%CI 0.14 - 0.42）。根据拟合的综合受试者工作特征曲线（SROC），曲线下面积（AUC）和Q指数分别为0.89和0.82。存在发表偏倚（t = 2.46，P = 0.039）。（2）Meta回归分析表明，阈值效应和包括场强、脉冲序列、重复时间（TR）和回波时间（TE）在内的评估协变量均不是异质性来源（所有P值>0.05）。（3）亚组荟萃分析：合并敏感度和特异度分别为0.79和0.72。PLR和NLR分别为3.49和0.20。AUC和Q指数分别为0.92和0.85。在MRS研究中使用tCho SNR标准有助于区分乳腺恶性和良性病变。然而，由于发表偏倚，合并诊断指标可能被高估。以tCho SNR≥2作为恶性肿瘤的截断值可获得更高的诊断准确性。
