Treadwell Jonathan R, Zafar Hanna M, Mitchell Matthew D, Tipton Kelley, Teitelbaum Ursina, Jue Jane
From the *ECRI-Penn Evidence-Based Practice Center, Plymouth Meeting, PA; †Department of Radiology, and ‡Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Pancreas. 2016 Jul;45(6):789-95. doi: 10.1097/MPA.0000000000000524.
Imaging tests are central to the diagnosis and staging of pancreatic adenocarcinoma. We performed a systematic review and meta-analysis of the pertinent evidence on 5 imaging tests (computed tomography (CT), magnetic resonance imaging, CT angiography, endoscopic ultrasound with fine-needle aspiration, and combined positron emission tomography with CT). Searches of several databases up to March 1, 2014, yielded 9776 articles, and 24 provided comparative effectiveness of 2 or more imaging tests. Multiple reviewers applied study inclusion criteria, extracted data from each study, rated the risk of bias, and graded the strength of evidence. Data included accuracy of diagnosis and resectability in primary untreated pancreatic adenocarcinoma, including tumor stage, nodal stage, metastases, and vascular involvement. Where possible, study results were combined using bivariate meta-analysis. Studies were at low or moderate risk of bias. Most comparisons between imaging tests were insufficient to permit conclusions, due to imprecision or inconsistency among study results. However, moderate-grade evidence revealed that CT and magnetic resonance imaging had similar sensitivities and specificities for both diagnosis and vascular involvement. Other conclusions were based on low-grade evidence. In general, more direct evidence is needed to inform decisions about imaging tests for pancreatic adenocarcinoma.
影像学检查对于胰腺腺癌的诊断和分期至关重要。我们对5种影像学检查（计算机断层扫描（CT）、磁共振成像、CT血管造影、超声内镜引导下细针穿刺活检以及正电子发射断层显像与CT联合检查）的相关证据进行了系统综述和荟萃分析。检索截至2014年3月1日的多个数据库，共获得9776篇文章，其中24篇提供了2种或更多影像学检查的比较有效性。多名评审员应用研究纳入标准，从每项研究中提取数据，评估偏倚风险，并对证据强度进行分级。数据包括原发性未经治疗的胰腺腺癌的诊断准确性和可切除性，包括肿瘤分期、淋巴结分期、转移情况以及血管受累情况。在可能的情况下，使用双变量荟萃分析合并研究结果。研究的偏倚风险较低或中等。由于研究结果不精确或不一致，大多数影像学检查之间的比较不足以得出结论。然而，中等强度的证据表明，CT和磁共振成像在诊断和血管受累方面具有相似的敏感性和特异性。其他结论基于低强度证据。总体而言，需要更多直接证据来为胰腺腺癌影像学检查的决策提供依据。
