腮腺细针穿刺抽吸术的敏感性、特异性及检验后概率：一项系统评价与Meta分析
Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis.
作者信息
Liu C Carrie, Jethwa Ashok R, Khariwala Samir S, Johnson Jonas, Shin Jennifer J
机构信息
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada.
Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
出版信息
Otolaryngol Head Neck Surg. 2016 Jan;154(1):9-23. doi: 10.1177/0194599815607841. Epub 2015 Oct 1.
OBJECTIVES
(1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA.
DATA SOURCES
Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts.
REVIEW METHODS
Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I(2) statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios.
RESULTS
The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I(2) point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509-0.982) and a specificity of 0.995 (95% CI, 0.960-0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030-0.075) and 0.147 (95% CI, 0.106-0.188), respectively.
CONCLUSION
FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.
目的
（1）分析细针穿刺抽吸（FNA）鉴别腮腺疾病良恶性的敏感性和特异性。（2）确定腮腺FNA后恶性肿瘤的预期概率以及非诊断性和不确定细胞学的概率。
数据来源
对PubMed、Embase和Cochrane中央登记库进行了独立核实的计算机检索。并辅以手工检索和内容专家的意见。
综述方法
纳入/排除标准明确为腮腺肿块的诊断、FNA和手术切除干预，以及细胞学和手术组织病理学结果的计数。主要结局为敏感性、特异性和恶性肿瘤的验后概率。用I²统计量评估异质性。通过二级混合逻辑回归模型进行Meta分析。通过合并似然比绘制贝叶斯列线图。
结果
系统评价产生了70项符合标准的研究，其中63项包含的数据可用于计算数值结果（n = 5647例患者；2a级）并考虑进行Meta分析。在前瞻性、纳入连续患者、描述所采用的FNA技术并使用超声引导的研究中进行亚组分析。除前瞻性获得的结果和超声引导的结果外，所有分析的I²点估计均>70%。在前瞻性子组中，汇总分析显示敏感性为0.882（95%置信区间[95%CI]，0.509 - 0.982），特异性为0.995（95%CI，0.960 - 0.999）。非诊断性和不确定细胞学的概率分别为0.053（95%CI，0.030 - 0.075）和0.147（95%CI，0.106 - 0.188）。
结论
FNA在鉴别腮腺良恶性病变方面具有中等敏感性和高特异性。各研究之间存在相当大的异质性。
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