Zhou Luyao, Shan Quanyuan, Tian Wenshuo, Wang Zhu, Liang Jinyu, Xie Xiaoyan
1 All authors: Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou, 510080, China.
AJR Am J Roentgenol. 2016 May;206(5):W73-82. doi: 10.2214/AJR.15.15336. Epub 2016 Mar 24.
The purpose of this meta-analysis was to summarize the evidence on the accuracy of various ultrasound findings for excluding a diagnosis of biliary atresia.
We searched MEDLINE and the Web of Science databases for the period from January 1990 to May 2015. To be included, studies had to satisfy two criteria. First, the data needed to include 2 × 2 contingency data on the diagnostic accuracy of ultrasound in identifying biliary atresia in at least 10 patients with and 10 patients without disease. Second, the study needed to use surgery or biopsy for biliary atresia and surgery, biopsy, clinical follow-up, or some combination of the three as the reference standard for the exclusion of biliary atresia. The methodologic quality of each study was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies tool. Estimated sensitivity and specificity of each ultrasound characteristic were calculated using a random-effects model.
Twenty-three studies published during 1998-2015 were included. Summary sensitivity and specificity were 0.85 (95% CI, 0.76-0.91) and 0.92 (95% CI, 0.81-0.97), respectively, for gallbladder abnormalities in 19 studies; 0.74 (95% CI, 0.61-0.84) and 0.97 (95% CI, 0.95-0.99), respectively, for triangular cord sign in 20 studies; and 0.95 (95% CI, 0.70-0.99) and 0.89 (95% CI, 0.79-0.94), respectively, for the combination of the triangular cord sign and gallbladder abnormalities in five studies. Subgroup analysis of an absent gallbladder in 10 studies yielded a summary specificity of 0.99 (95% CI, 0.93-1.00).
The triangular cord sign and gallbladder abnormalities are the two most accurate and widely accepted ultrasound characteristics for diagnosing or excluding biliary atresia. Other ultrasound characteristics are less valuable for diagnosis or exclusion of biliary atresia.
本荟萃分析的目的是总结各种超声检查结果在排除胆道闭锁诊断方面准确性的证据。
我们检索了1990年1月至2015年5月期间的MEDLINE和科学引文索引数据库。纳入的研究必须满足两条标准。第一，数据需包含关于超声诊断胆道闭锁准确性的2×2列联表数据，其中至少有10例患病患者和10例未患病患者。第二，研究需将手术或活检用于胆道闭锁诊断，以及将手术、活检、临床随访或这三者的某种组合作为排除胆道闭锁的参考标准。使用诊断准确性研究质量评估工具第2版对每项研究的方法学质量进行评估。使用随机效应模型计算每个超声特征的估计敏感性和特异性。
纳入了1998年至2015年期间发表的23项研究。19项研究中胆囊异常的汇总敏感性和特异性分别为0.85（95%CI，0.76 - 0.91）和0.92（95%CI，0.81 - 0.97）；20项研究中三角索征的汇总敏感性和特异性分别为0.74（95%CI，0.61 - 0.84）和0.97（95%CI，0.95 - 0.99）；5项研究中三角索征和胆囊异常组合的汇总敏感性和特异性分别为0.95（95%CI，0.70 - 0.99）和0.89（95%CI，0.79 - 0.94）。10项关于胆囊缺如的亚组分析得出汇总特异性为0.99（95%CI，0.93 - 1.00）。
三角索征和胆囊异常是诊断或排除胆道闭锁最准确且被广泛认可的两个超声特征。其他超声特征在诊断或排除胆道闭锁方面价值较小。
