Hu Jing-Hong, Tang Jui-Hsiang, Lin Cheng-Hui, Chu Yin-Yi, Liu Nai-Jen
Department of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
J Investig Med. 2018 Jan;66(1):52-61. doi: 10.1136/jim-2017-000472. Epub 2017 Sep 14.
This meta-analysis was performed to determine the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in assessing primary cholangiocarcinoma (CCA) and CCA with lymph node and distant metastasis. A literature search for studies reporting the use of 18F-FDG-PET for preoperative work-up/staging in patients with CCA was performed. Diagnostic OR (DOR) was used as an index of diagnostic performance of FDG-PET/CT in predicting primary CCA, lymph node metastases, and distant metastases. The pooled DOR was 9.34 (95% CI 4.27 to 20.42) and the area under the summary receiver operating characteristic (SROC) curve was 0.8643 (SE=0.0362), indicating overall good discriminatory test performance in predicting primary CCA. Subgroup analyses based on the primary tumor site showed better diagnostic performance for intrahepatic CCA (DOR=54.44, 95% CI 13.44 to 220.49), both intrahepatic and extrahepatic CCA (DOR=32.96, 95% CI 1.41 to 768.80) and gallbladder cancer (DOR=12.93, 95% CI 1.97 to 84.80), than for extrahepatic CCA (DOR=2.55, 95% CI 0.71 to 9.20) and hilar CCA (DOR=2.75, 95% CI 0.17 to 43.72). The pooled DOR for the prediction of lymph nodes metastases in 10 studies was 11.34 (95% CI 4.79 to 26.80), with moderate heterogeneity (Cochran Q=15.14, p=0.0872, I=40.5%). The area under the SROC curve was 0.8584 (SE=0.0729). In conclusion, 18F-FDG-PET and PET/CT were found to be accurate in the evaluation of primary tumors, lymph node metastasis, and distant metastasis in patients with CCA.
本荟萃分析旨在确定18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET）在评估原发性胆管癌（CCA）以及伴有淋巴结和远处转移的CCA时的诊断准确性。我们对报告将18F-FDG-PET用于CCA患者术前检查/分期的研究进行了文献检索。诊断比值比（DOR）被用作FDG-PET/CT预测原发性CCA、淋巴结转移和远处转移的诊断性能指标。汇总DOR为9.34（95%可信区间4.27至20.42），汇总受试者工作特征（SROC）曲线下面积为0.8643（标准误=0.0362），表明在预测原发性CCA方面总体具有良好的鉴别检验性能。基于原发肿瘤部位的亚组分析显示，肝内CCA（DOR=54.44，95%可信区间13.44至220.49）、肝内和肝外CCA（DOR=32.96，95%可信区间1.41至768.80）以及胆囊癌（DOR=12.93，95%可信区间1.97至84.80）的诊断性能优于肝外CCA（DOR=2.55，95%可信区间0.71至9.20）和肝门部CCA（DOR=2.75，95%可信区间0.17至43.72）。10项研究中预测淋巴结转移的汇总DOR为11.34（95%可信区间4.79至26.80），具有中度异质性（Cochran Q=15.14，p=0.0872，I=40.5%）。SROC曲线下面积为0.8584（标准误=0.0729）。总之，发现18F-FDG-PET和PET/CT在评估CCA患者的原发性肿瘤、淋巴结转移和远处转移方面是准确的。
