Mehlum Camilla S, Rosenberg Tine, Dyrvig Anne-Kirstine, Groentved Aagot Moeller, Kjaergaard Thomas, Godballe Christian
Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Odense, Denmark.
Department of Surgery, Odense University Hospital, Svendborg, Denmark.
Laryngoscope. 2018 Jan;128(1):168-176. doi: 10.1002/lary.26721. Epub 2017 Jun 10.
The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia.
PubMed, Embase, Cochrane, and Scopus databases.
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created.
The combined sensitivity of five studies (n = 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n = 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97).
The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery. Laryngoscope, 128:168-176, 2018.
2011年的Ni血管变化分类在评估咽喉部病变方面有充分记录，主要聚焦于癌症。在手术规划中，区分肿瘤与非肿瘤可能更为重要。我们旨在评估Ni分类预测喉或下咽肿瘤的能力，并研究改变临界值是否会支持欧洲喉科学会（ELS）最近提出的将垂直血管变化作为肿瘤指征的提议。
PubMed、Embase、Cochrane和Scopus数据库。
根据系统评价和Meta分析的首选报告项目声明进行系统评价和Meta分析。我们系统检索了2011年至2016年的出版物。对所有检索到的研究进行了综述和定性评估。计算了具有两种不同临界值的Ni分类的合并敏感性和特异性，并绘制了气泡图和总结性受试者工作特征曲线。
五项研究（n = 687）将Ni IV-V型定义为检测阳性，其合并敏感性为0.89（95%置信区间[CI]：0.76 - 0.95），特异性为0.82（95%CI：0.72 - 0.89）。四项研究（n = 624）将Ni V型定义为检测阳性，其等效合并敏感性为0.82（95%CI：0.75 - 0.87），特异性为0.93（95%CI：0.82 - 0.97）。
Ni分类在预测肿瘤方面的诊断准确性较高，两种分析的临界值之间无显著差异。从临床角度来看，实施提议的ELS血管变化分类似乎合理，准确性相当。必须注意让患者面临不必要手术的伴随风险。《喉镜》，2018年，第128卷，第168 - 176页。
