超声造影在胰腺实性病变（SLP）鉴别诊断中的价值：一项系统评价和荟萃分析。
Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): A systematic review and a meta-analysis.
作者信息
Ran Li, Zhao Wenli, Zhao Ye, Bu Huaien
机构信息
Graduate School, Tianjin University of Traditional Chinese Medicine Department of Neurology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, People's Republic of China Department of Chemical Engineering, University of Florida, Gainesville, FL College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.
出版信息
Medicine (Baltimore). 2017 Jul;96(28):e7463. doi: 10.1097/MD.0000000000007463.
BACKGROUND
Contrast-enhanced ultrasound (CEUS) is considered a novel method for diagnosing pancreatic cancer, but currently, there is no conclusive evidence of its accuracy. Using CEUS in discriminating between pancreatic carcinoma and other pancreatic lesions, we aimed to evaluate the diagnostic accuracy of CEUS in predicting pancreatic tumours.
METHODS
Relevant studies were selected from the PubMed, Cochrane Library, Elsevier, CNKI, VIP, and WANFANG databases dating from January 2006 to May 2017. The following terms were used as keywords: "pancreatic cancer" OR "pancreatic carcinoma," "contrast-enhanced ultrasonography" OR "contrast-enhanced ultrasound" OR "CEUS," and "diagnosis." The selection criteria are as follows: pancreatic carcinomas diagnosed by CEUS while the main reference standard was surgical pathology or biopsy (if it involved a clinical diagnosis, particular criteria emphasized); SonoVue or Levovist was the contrast agent; true positive, false positive, false negative, and true negative rates were obtained or calculated to construct the 2 × 2 contingency table; English or Chinese articles; at least 20 patients were enrolled in each group. The Quality Assessment for Studies of Diagnostic Accuracy was employed to evaluate the quality of articles. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver-operating characteristic curves, and the area under curve were evaluated to estimate the overall diagnostic efficiency. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence intervals (CIs) were calculated with fixed-effect models.
RESULTS
Eight of 184 records were eligible for a meta-analysis after independent scrutinization by 2 reviewers. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were 0.86 (95% CI 0.81-0.90), 0.75 (95% CI 0.68-0.82), 3.56 (95% CI 2.64-4.78), 0.19 (95% CI 0.13-0.27), and 22.260 (95% CI 8.980-55.177), respectively. The area under the SROC curve was 0.9088.
CONCLUSION
CEUS has a satisfying pooled sensitivity and specificity for discriminating pancreatic cancer from other pancreatic lesions.
背景
超声造影（CEUS）被认为是诊断胰腺癌的一种新方法，但目前尚无确凿证据证明其准确性。我们旨在通过使用CEUS鉴别胰腺癌和其他胰腺病变，评估CEUS预测胰腺肿瘤的诊断准确性。
方法
从2006年1月至2017年5月的PubMed、Cochrane图书馆、爱思唯尔、中国知网、维普和万方数据库中选取相关研究。使用以下术语作为关键词：“胰腺癌”或“胰腺导管腺癌”、“超声造影”或“超声造影检查”或“CEUS”以及“诊断”。选择标准如下：以CEUS诊断胰腺癌，主要参考标准为手术病理或活检（若涉及临床诊断，则强调特定标准）；造影剂为声诺维或Levovist；获取或计算真阳性、假阳性、假阴性和真阴性率以构建2×2列联表；英文或中文文章；每组至少纳入20例患者。采用诊断准确性研究的质量评估方法评估文章质量。评估合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比、汇总受试者工作特征曲线及曲线下面积，以估计总体诊断效能。采用固定效应模型计算合并敏感度、特异度、阳性似然比和阴性似然比及其95%置信区间（CIs）。
结果
经过两名审阅者独立审查，184条记录中有8条符合荟萃分析的条件。合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.86（95%CI 0.81 - 0.90）、0.75（95%CI 0.68 - 0.82）、3.56（95%CI 2.64 - 4.78）、0.19（95%CI 0.13 - 0.27）和22.260（95%CI 8.980 - 55.177）。SROC曲线下面积为0.9088。
结论
CEUS在鉴别胰腺癌与其他胰腺病变方面具有令人满意的合并敏感度和特异度。
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