Iftikhar Imran H, Musani Ali I
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA.
Ther Adv Respir Dis. 2015 Oct;9(5):207-16. doi: 10.1177/1753465815589698. Epub 2015 Jun 17.
Both autofluorescence imaging bronchoscopy and narrow-band imaging have shown promise in the detection of premalignant airway lesions, each by utilizing different bandwidths of lights for better characterization of the mucosal and submucosal vascular grid. Since previously published meta-analyses have shown poor specificity of autofluorescence imaging bronchoscopy, we specifically studied the diagnostic accuracy of narrow-band imaging alone and in combination with autofluorescence imaging bronchoscopy in the detection of premalignant airway lesions.
After an extensive search of eligible studies from PubMed and Medline, extracted data were pooled with weighted averages. Symmetrical summary-receiver operating characteristic curves were constructed to summarize the results quantitatively. Study heterogeneity was assessed by the I(2) index.
Analysis of data from eight studies on narrow-band imaging showed a pooled sensitivity of 0.80 [95% confidence interval (CI): 0.77-0.83] and a pooled specificity of 0.84 (95% CI: 0.81-0.86). Summary-receiver operating characteristic curves from the data on narrow-band imaging calculated an area-under-the-curve of 0.908 (standard error 0.01). The diagnostic odds ratio of narrow-band imaging was 31.49 (95% CI: 12.17-81.45). Data from studies where narrow-band imaging and autofluorescence imaging bronchoscopy were used together showed a pooled sensitivity, specificity, area-under-the-curve and diagnostic odds ratios of 0.86 (95% CI: 0.82-0.89), 0.75 (95% CI: 0.71-0.79), 0.964 (standard error 0.05) and 27.96 (95% CI: 3.04-257.21), respectively.
Our findings indicate that in the evaluation of premalignant airway lesions, narrow-band imaging has a higher sensitivity, specificity and diagnostic odds ratios compared with autofluorescence imaging bronchoscopy. However, combining autofluorescence imaging bronchoscopy and narrow-band imaging does not significantly improve test performance characteristics.
自体荧光成像支气管镜检查和窄带成像在检测气道癌前病变方面均显示出前景，二者均通过利用不同带宽的光来更好地表征黏膜和黏膜下血管网格。由于先前发表的荟萃分析显示自体荧光成像支气管镜检查的特异性较差，我们专门研究了窄带成像单独以及与自体荧光成像支气管镜检查联合使用在检测气道癌前病变方面的诊断准确性。
在对来自PubMed和Medline的符合条件的研究进行广泛检索后，提取的数据采用加权平均值进行汇总。构建对称的汇总接受者操作特征曲线以定量总结结果。通过I(2)指数评估研究异质性。
对八项关于窄带成像的研究数据进行分析，结果显示汇总敏感性为0.80[95%置信区间(CI)：0.77 - 0.83]，汇总特异性为0.84(95%CI：0.81 - 0.86)。根据窄带成像数据计算的汇总接受者操作特征曲线下面积为0.908(标准误差0.01)。窄带成像的诊断比值比为31.49(95%CI：12.17 - 81.45)。同时使用窄带成像和自体荧光成像支气管镜检查的研究数据显示，汇总敏感性、特异性、曲线下面积和诊断比值比分别为0.86(95%CI：0.82 - 0.89)、0.75(95%CI：0.71 - 0.79)、0.964(标准误差0.05)和27.96(95%CI：3.04 - 257.21)。
我们的研究结果表明，在评估气道癌前病变时，与自体荧光成像支气管镜检查相比窄带成像具有更高的敏感性、特异性和诊断比值比。然而，将自体荧光成像支气管镜检查和窄带成像联合使用并不能显著提高检测性能特征。
