扩散加权成像在鉴别头颈部鳞癌转移性淋巴结中的诊断价值：系统评价和荟萃分析。
The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.
机构信息
From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
出版信息
AJNR Am J Neuroradiol. 2018 Oct;39(10):1889-1895. doi: 10.3174/ajnr.A5813. Epub 2018 Sep 13.
BACKGROUND
Accurate lymph node staging is crucial for proper treatment planning for metastasis in patients with head and neck squamous cell carcinoma.
PURPOSE
Our aim was to evaluate the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes in patients with head and neck squamous cell carcinoma and to identify optimal cutoff values for ADC.
DATA SOURCES
A computerized literature search was performed to identify relevant original articles in Ovid MEDLINE and EMBASE.
STUDY SELECTION
Studies evaluating the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes were selected.
DATA ANALYSIS
Diagnostic meta-analysis was conducted with a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was obtained. Meta-regression was also performed.
DATA SYNTHESIS
Nine studies with 337 patients were included. In all studies, ADC values derived from metastatic lymph nodes were significantly lower than ADC values derived from benign lymph nodes. The median ADC cutoff value was 0.965 × 10 mm/s. The pooled sensitivity and specificity for the diagnostic performance of DWI in differentiating metastatic lymph nodes from benign lymph nodes were 90% (95% CI, 84%-94%) and 88% (95% CI, 80%-93%), respectively. In the meta-regression, sensitivity was significantly higher in the studies using a 3-mm slice thickness (93% [95% CI, 88%-98%]) than in studies using a slice thickness of >3 mm (86% [95% CI, 77%-95%], < .01).
LIMITATIONS
A small number of studies were included in our meta-analysis.
CONCLUSIONS
DWI demonstrated high diagnostic performance for differentiating metastatic lymph nodes from benign lymph nodes in patients with head and neck squamous cell carcinoma, and the median ADC cutoff value was 0.965 × 10 mm/s. A 3-mm DWI slice thickness can provide a slight improvement in sensitivity.
背景
对头颈鳞状细胞癌患者进行准确的淋巴结分期对于制定适当的转移治疗计划至关重要。
目的
我们旨在评估 DWI 区分头颈鳞状细胞癌患者转移性与良性颈淋巴结的诊断性能，并确定 ADC 的最佳截断值。
数据来源
通过计算机检索 Ovid MEDLINE 和 EMBASE 中的相关原始文献。
研究选择
选择评估 DWI 区分转移性与良性颈淋巴结的诊断性能的研究。
数据分析
采用双变量随机效应模型进行诊断荟萃分析，并获得层次综合受试者工作特征曲线。还进行了元回归分析。
数据综合
纳入了 9 项共 337 例患者的研究。所有研究中，转移性淋巴结的 ADC 值均显著低于良性淋巴结的 ADC 值。中位 ADC 截断值为 0.965×10 mm/s。DWI 区分转移性与良性淋巴结的诊断性能的汇总敏感度和特异度分别为 90%（95%CI，84%-94%）和 88%（95%CI，80%-93%）。在元回归中，使用 3-mm 层厚的研究的敏感度显著高于使用层厚>3mm 的研究（93%[95%CI，88%-98%]比 86%[95%CI，77%-95%]，<0.01）。
局限性
我们的荟萃分析纳入的研究数量较少。
结论
DWI 对头颈鳞状细胞癌患者转移性与良性淋巴结的区分具有较高的诊断性能，中位 ADC 截断值为 0.965×10 mm/s。使用 3-mm DWI 层厚可以略微提高敏感度。
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