From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.).
Radiology. 2016 Oct;281(1):86-98. doi: 10.1148/radiol.2016151631. Epub 2016 Apr 25.
Purpose To summarize existing evidence of thoracic magnetic resonance (MR) imaging in determining the nodal status of non-small cell lung cancer (NSCLC) with the aim of elucidating its diagnostic value on a per-patient basis (eg, in treatment decision making) and a per-node basis (eg, in target volume delineation for radiation therapy), with results of cytologic and/or histologic examination as the reference standard. Materials and Methods A systematic literature search for original diagnostic studies was performed in PubMed, Web of Science, Embase, and MEDLINE. The methodologic quality of each study was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2, tool. Hierarchic summary receiver operating characteristic curves were generated to estimate the diagnostic performance of MR imaging. Subgroup analyses, expressed as relative diagnostic odds ratios (DORs) (rDORs), were performed to evaluate whether publication year, methodologic quality, and/or method of evaluation (qualitative [ie, lesion size and/or morphology] vs quantitative [eg, apparent diffusion coefficients in diffusion-weighted images]) affected diagnostic performance. Results Twelve of 2551 initially identified studies were included in this meta-analysis (1122 patients; 4302 lymph nodes). On a per-patient basis, the pooled estimates of MR imaging for sensitivity, specificity, and DOR were 0.87 (95% confidence interval [CI]: 0.78, 0.92), 0.88 (95% CI: 0.77, 0.94), and 48.1 (95% CI: 23.4, 98.9), respectively. On a per-node basis, the respective measures were 0.88 (95% CI: 0.78, 0.94), 0.95 (95% CI: 0.87, 0.98), and 129.5 (95% CI: 49.3, 340.0). Subgroup analyses suggested greater diagnostic performance of quantitative evaluation on both a per-patient and per-node basis (rDOR = 2.76 [95% CI: 0.83, 9.10], P = .09 and rDOR = 7.25 [95% CI: 1.75, 30.09], P = .01, respectively). Conclusion This meta-analysis demonstrated high diagnostic performance of MR imaging in staging hilar and mediastinal lymph nodes in NSCLC on both a per-patient and per-node basis. (©) RSNA, 2016 Online supplemental material is available for this article.
目的 总结现有关于胸部磁共振成像（MR 成像）在确定非小细胞肺癌（NSCLC）淋巴结状态方面的证据，旨在明确其在个体患者（如治疗决策）和每个淋巴结（如放射治疗靶区勾画）基础上的诊断价值，以细胞学和/或组织学检查结果为参考标准。
材料与方法 在 PubMed、Web of Science、Embase 和 MEDLINE 中进行了原始诊断研究的系统文献检索。使用 QUADAS-2 工具评估每项研究的方法学质量。生成层次汇总受试者工作特征曲线，以评估 MR 成像的诊断性能。进行亚组分析，以相对诊断优势比（rDOR）表示，以评估发表年份、方法学质量和/或评估方法（定性[即病变大小和/或形态]与定量[例如，扩散加权图像中的表观扩散系数]）是否影响诊断性能。
结果 2551 项初步确定的研究中，有 12 项（1122 例患者；4302 个淋巴结）纳入本荟萃分析。基于个体患者，MR 成像的汇总敏感性、特异性和 DOR 估计值分别为 0.87（95%置信区间[CI]：0.78，0.92）、0.88（95% CI：0.77，0.94）和 48.1（95% CI：23.4，98.9）。基于每个淋巴结，相应的指标分别为 0.88（95% CI：0.78，0.94）、0.95（95% CI：0.87，0.98）和 129.5（95% CI：49.3，340.0）。亚组分析表明，基于个体患者和每个淋巴结的定量评估诊断性能更高（rDOR = 2.76[95% CI：0.83，9.10]，P =.09；rDOR = 7.25[95% CI：1.75，30.09]，P =.01）。
结论 本荟萃分析表明，MR 成像在 NSCLC 患者的肺门和纵隔淋巴结分期中具有较高的诊断性能，无论是基于个体患者还是每个淋巴结。（©）RSNA，2016 在线补充材料可在本文中获得。
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