Wu Fashuai, Huang Yu, Huang Xin, Fang Silang, Huang Xiaohui, Huang Xin, Zhang Zhicai, Shao Zengwu
Department of Orthopaedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Otorhinolaryngology, The Third Hospital of Wuhan City, Wuhan, China.
Front Oncol. 2020 May 22;10:762. doi: 10.3389/fonc.2020.00762. eCollection 2020.
There have been many attempts to preoperatively evaluate the chemotherapy response of osteosarcoma patients using Tc-MIBI scintigraphy. However, the evaluations were lacking in consistency. We performed this systematic review and meta-analysis to systematically evaluate the ability of Tc-MIBI scintigraphy in preoperatively assessing the response of osteosarcoma patients to neoadjuvant chemotherapy. For this systematic review and meta-analysis, PubMed, Web of Science, OVID, the Cochrane Library, and CNKI were searched. Eligible studies were included based on the defined criteria. The index test was Tc-MIBI scintigraphy, the reference standard was tumor necrosis rate. Quality Assessment of Diagnostic Accuracy Studies-2 was adopted for quality assessment of included studies. The statistical pooling analysis, meta-regression analysis, subgroup analysis, sensitivity analysis, and publication bias of our research were performed using STATA 15. Eight articles with 189 osteosarcoma patients were included in this systematic review and meta-analysis. Our results demonstrated that the threshold effect of our meta-analysis was significant. The uptake change ratio of Tc-MIBI scintigraphy had a pooled sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and the area under curve of 0.98 (0.58-1.00), 0.68 (0.47-0.84), 3.1 (1.7-5.5), 0.03 (0.00-0.90), 103 (4-3,003), and 0.91 (0.88-0.93) in preoperative assessment of response of osteosarcoma patients to neoadjuvant chemotherapy. Meta-regression analysis and subgroup analysis indicated the factors of method and cut off value may introduce the heterogeneity. The pooled sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and the area under curve of washout rate of Tc-MIBI were 0.87 (0.69-0.95), 0.91 (0.75-0.97), 9.3 (3.2-27.0), 0.15 (0.06-0.37), 64 (14-301), and 0.89 (0.86-0.92), respectively. Sensitivity analysis and publication bias demonstrated our meta-analysis was reliable. Both the ΔUR and WR derived from Tc-MIBI scintigraphy were valuable in preoperatively assessing the response of osteosarcoma patients to neoadjuvant chemotherapy, and ΔUR may possess a more outstanding diagnostic accuracy than WR.
已经有许多尝试使用锝-甲氧基异丁基异腈（Tc-MIBI）闪烁扫描术对骨肉瘤患者的化疗反应进行术前评估。然而，这些评估缺乏一致性。我们进行了这项系统评价和荟萃分析，以系统评估Tc-MIBI闪烁扫描术在术前评估骨肉瘤患者对新辅助化疗反应的能力。对于这项系统评价和荟萃分析，检索了PubMed、科学网、OVID、考克兰图书馆和中国知网。根据既定标准纳入符合条件的研究。索引测试为Tc-MIBI闪烁扫描术，参考标准为肿瘤坏死率。采用诊断准确性研究质量评估-2对纳入研究进行质量评估。我们的研究使用STATA 15进行统计合并分析、meta回归分析、亚组分析、敏感性分析和发表偏倚分析。本系统评价和荟萃分析纳入了8篇涉及189例骨肉瘤患者的文章。我们的结果表明，我们的荟萃分析存在显著的阈值效应。在术前评估骨肉瘤患者对新辅助化疗的反应时，Tc-MIBI闪烁扫描术的摄取变化率的合并敏感性、特异性、阳性和阴性似然比、诊断比值比以及曲线下面积分别为0.98（0.58 - 1.00）、0.68（0.47 - 0.84）、3.1（1.7 - 5.5）、0.03（0.00 - 0.90）、103（4 - 3003）和0.91（0.88 - 0.93）。Meta回归分析和亚组分析表明，方法和截断值因素可能会引入异质性。Tc-MIBI洗脱率的合并敏感性、特异性、阳性和阴性似然比、诊断比值比以及曲线下面积分别为0.87（0.69 - 0.95）、0.91（0.75 - 0.97）、9.3（3.2 - 27.0）、0.15（0.06 - 0.37）、64（14 - 301）和0.89（0.86 - 0.92）。敏感性分析和发表偏倚表明我们的荟萃分析是可靠的。源自Tc-MIBI闪烁扫描术的ΔUR和WR在术前评估骨肉瘤患者对新辅助化疗的反应方面均有价值，并且ΔUR可能比WR具有更出色的诊断准确性。
