Dai Guidong, Liang Kali, Xiao Zhengyuan, Yang Qin, Yang Shugen
Department of Radiography, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
J BUON. 2019 Nov-Dec;24(6):2333-2340.
This study systematically evaluated the potential influences of diffusion- weighted imaging (DWI) on the initial diagnosis, clinical decision making and diagnostic accuracy of ovarian cancer in the follow-up period.
Literature on the correlation between DWI and diagnosis of ovarian cancer were searched from PubMed, Embase, Cochrane Library, and Web of Science published before January 1, 2019. References in enrolled eligible literature were manually reviewed. Quality assessment on the diagnostic accuracy was performed using the QUADAS scale. Receiver operating characteristics (ROC) curve was depicted using STATA 12.0. Study heterogeneity and its sources were determined. Sensitivity (SEN), specificity (SPF), positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic odds ratio (DOR) of eligible studies were calculated for depicting forest plot and summary of ROC curve (SROC). The area under the curve (AUC) was calculated.
A total of 15 articles involving 930 ovarian cancer cases and 832 control cases were enrolled. DWI was identified to exert a certain diagnostic value on ovarian cancer. The 95%CI of the merged SEN (91%, 95%CI=84-95%), SPF (85%, 95%CI=78-90%), +LR (6.18, 95%CI=4.17-9.15) and -LR (4.05, 95%CI=3.30-4.79) were calculated using the random-effects model due to the slight heterogeneity among these studies. AUC was 0.94 (95%CI=0.91-0.96). Subgroup analysis in Asian population obtained the following results: SEN was 85% (95%CI=78-91%), SPF 83% (95%CI=72-90%), +LR 0.18 (95%CI=0.11-0.27), -LR 3.34 (95%CI=2.60-4.09) and DOR 3.34 (95%CI=2.60-4.09); AUC was 0.91 (95%CI=0.88-0.93). In Caucasian population, SEN was 96% (95%CI=83-99%), SPF 89% (95%CI=84-93%), +LR 41.36 (95%CI=5.95-287.48), -LR 0.06 (95%CI=0.02-0.18) and DOR 5.31(95%CI=3.93-6.69); AUC was 0.94 (95%CI=0.91-0.96).
This meta-analysis proved that DWI exerted a relatively high sensitivity and specificity in diagnosing ovarian cancer, especially in the Caucasian population. This conclusion still needs to be further verified in a multi-center study with a large sample size.
本研究系统评估了扩散加权成像（DWI）对卵巢癌初始诊断、临床决策及随访期诊断准确性的潜在影响。
从PubMed、Embase、Cochrane图书馆及Web of Science中检索2019年1月1日前发表的关于DWI与卵巢癌诊断相关性的文献。对纳入的合格文献的参考文献进行人工检索。采用QUADAS量表对诊断准确性进行质量评估。使用STATA 12.0绘制受试者工作特征（ROC）曲线。确定研究异质性及其来源。计算合格研究的敏感性（SEN）、特异性（SPF）、阳性似然比（+LR）、阴性似然比（-LR）和诊断比值比（DOR），以绘制森林图和ROC曲线总结（SROC）。计算曲线下面积（AUC）。
共纳入15篇文章，涉及930例卵巢癌病例和832例对照病例。DWI被确定对卵巢癌具有一定的诊断价值。由于这些研究之间存在轻微异质性，使用随机效应模型计算合并后的SEN（91%，95%CI=84-95%）、SPF（85%，95%CI=78-90%）、+LR（6.18，95%CI=4.17-9.15）和-LR（4.05，95%CI=3.30-4.79）的95%CI。AUC为0.94（95%CI=0.91-0.96）。亚洲人群亚组分析结果如下：SEN为85%（95%CI=78-91%），SPF为83%（95%CI=72-90%），+LR为0.18（95%CI=0.11-0.27），-LR为3.34（95%CI=2.60-4.09），DOR为3.34（95%CI=2.60-4.09）；AUC为0.91（95%CI=0.88-0.93）。在白种人群中，SEN为96%（95%CI=83-99%），SPF为89%（95%CI=84-93%），+LR为41.36（95%CI=5.95-287.48），-LR为0.06（95%CI=0.02-0.18），DOR为5.31（95%CI=3.93-6.69）；AUC为0.94（95%CI=0.91-0.96）。
本荟萃分析证明DWI在诊断卵巢癌方面具有较高的敏感性和特异性，尤其是在白种人群中。该结论仍需在大样本多中心研究中进一步验证。
