Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
School of Health Sciences, Faculty of Health and Wellbeing, University of Central Lancashire, Lancashire, UK.
Eur Radiol. 2020 Jun;30(6):3310-3323. doi: 10.1007/s00330-020-06661-8. Epub 2020 Feb 15.
A systematic review and meta-analysis were performed to determine the diagnostic performance of dynamic contrast-enhanced computed tomography (DCE-CT) for the differentiation between malignant and benign pulmonary nodules.
Ovid MEDLINE and EMBASE were searched for studies published up to October 2018 on the diagnostic accuracy of DCE-CT for the characterisation of pulmonary nodules. For the index test, studies with a minimum of a pre- and post-contrast computed tomography scan were evaluated. Studies with a reference standard of biopsy for malignancy, and biopsy or 2-year follow-up for benign disease were included. Study bias was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). The sensitivities, specificities, and diagnostic odds ratios were determined along with 95% confidence intervals (CIs) using a bivariate random effects model.
Twenty-three studies were included, including 2397 study participants with 2514 nodules of which 55.3% were malignant (1389/2514). The pooled accuracy results were sensitivity 94.8% (95% CI 91.5; 96.9), specificity 75.5% (69.4; 80.6), and diagnostic odds ratio 56.6 (24.2-88.9). QUADAS 2 assessment showed intermediate/high risk of bias in a large proportion of the studies (52-78% across the domains). No difference was present in sensitivity or specificity between subgroups when studies were split based on CT technique, sample size, nodule size, or publication date.
DCE-CT has a high diagnostic accuracy for the diagnosis of pulmonary nodules although study quality was indeterminate in a large number of cases.
• The pooled accuracy results were sensitivity 95.1% and specificity 73.8% although individual studies showed wide ranges of values. • This is comparable to the results of previous meta-analyses of PET/CT (positron emission tomography/computed tomography) diagnostic accuracy for the diagnosis of solitary pulmonary nodules. • Robust direct comparative accuracy and cost-effectiveness studies are warranted to determine the optimal use of DCE-CT and PET/CT in the diagnosis of SPNs.
本系统评价和荟萃分析旨在确定动态对比增强 CT（DCE-CT）在鉴别良恶性肺结节中的诊断性能。
检索 Ovid MEDLINE 和 EMBASE 数据库，检索截至 2018 年 10 月有关 DCE-CT 对肺结节特征描述的诊断准确性的研究。对于索引测试，评估至少进行了增强前和增强后 CT 扫描的研究。纳入了以活检为恶性肿瘤参考标准、活检或 2 年随访为良性疾病的研究。使用 QUADAS-2（诊断准确性研究的质量评估）评估研究偏倚。使用双变量随机效应模型确定灵敏度、特异性和诊断比值比及其 95%置信区间（CI）。
共纳入 23 项研究，共 2397 名研究参与者，共 2514 个结节，其中 55.3%为恶性（1389/2514）。汇总准确性结果为灵敏度 94.8%（95%CI 91.5%96.9%）、特异性 75.5%（69.4%80.6%）和诊断比值比 56.6（24.288.9）。QUADAS-2 评估显示，大多数研究存在中度/高度偏倚风险（各领域的比例为 52%78%）。根据 CT 技术、样本量、结节大小或发表日期对研究进行分组时，灵敏度或特异性无差异。
DCE-CT 对肺结节的诊断具有较高的准确性，但在许多情况下，研究质量不确定。
汇总准确性结果为灵敏度 95.1%和特异性 73.8%，尽管个别研究显示值的范围很广。
这与以前对孤立性肺结节诊断准确性的 PET/CT（正电子发射断层扫描/计算机断层扫描）的荟萃分析结果相当。
需要进行稳健的直接比较准确性和成本效益研究，以确定 DCE-CT 和 PET/CT 在 SPN 诊断中的最佳应用。
