Confocal Laser Endomicroscopy 诊断膀胱癌的性能：系统评价和荟萃分析。

Diagnostic Performance of Confocal Laser Endomicroscopy for the Detection of Bladder Cancer: Systematic Review and Meta-Analysis.

机构信息

Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.

Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

出版信息

Urol Int. 2020;104(7-8):523-532. doi: 10.1159/000508417. Epub 2020 Jun 18.

DOI:10.1159/000508417

PMID:32554957

Abstract

OBJECTIVE

To systematically evaluate the diagnostic efficacy of confocal laser endomicroscopy (CLE) in detection of bladder cancer.

METHODS

A systematic literature search on CLE in diagnosing bladder cancer in PubMed, Embase, and the Cochrane Library databases was performed. A bivariate meta-regression model was used for meta-analysis to evaluate the pooled diagnostic value of CLE.

RESULTS

A total of 5 eligible studies involving 302 lesions were available for this meta-analysis. In a per-lesion analysis, pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver-operating curve (SROC) area under the curve (AUC) of CLE for malignant lesions were 0.90 (95% confidence interval [CI]: 0.85-0.94), 0.72 (95% CI: 0.59-0.82), 3.20 (95% CI: 2.14-4.79), 0.14 (95% CI: 0.09-0.21), 23.27 (95% CI: 11.71-46.25), and 0.91 (95% CI: 0.89-0.94), respectively. For low-grade urothelial carcinomas, pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for CLE were 0.72 (95% CI: 0.57-0.84), 0.87 (95% CI: 0.77-0.93), 5.48 (95% CI: 3.12-9.62), 0.32 (95% CI: 0.20-0.50), 17.19 (95% CI: 8.01-36.89), and 0.85 (95% CI: 0.82-0.88), respectively. For high-grade urothelial carcinomas, pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for CLE were 0.82 (95% CI: 0.62-0.92), 0.84 (95% CI: 0.73-0.91), 4.96 (95% CI: 2.58-9.54), 0.22 (95% CI: 0.09-0.52), 22.49 (95% CI: 5.33-94.85), and 0.89 (95% CI: 0.86-0.91), respectively.

CONCLUSION

CLE is a promising endoscopy technique for real-time tumor grading of bladder cancer.

摘要

目的

系统评价共聚焦激光内镜（CLE）在膀胱癌诊断中的诊断效能。

方法

在 PubMed、Embase 和 Cochrane 图书馆数据库中进行了系统的 CLE 诊断膀胱癌的文献检索。使用双变量 meta 回归模型进行 meta 分析，以评估 CLE 的汇总诊断价值。

结果

共纳入 5 项符合条件的研究，涉及 302 个病灶，可用于本次 meta 分析。在病灶水平的分析中，CLE 对恶性病灶的汇总敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和汇总受试者工作特征（SROC）曲线下面积（AUC）分别为 0.90（95%置信区间 [CI]：0.85-0.94）、0.72（95% CI：0.59-0.82）、3.20（95% CI：2.14-4.79）、0.14（95% CI：0.09-0.21）、23.27（95% CI：11.71-46.25）和 0.91（95% CI：0.89-0.94）。对于低级别尿路上皮癌，CLE 的汇总敏感性、特异性、PLR、NLR、DOR 和 AUC 分别为 0.72（95% CI：0.57-0.84）、0.87（95% CI：0.77-0.93）、5.48（95% CI：3.12-9.62）、0.32（95% CI：0.20-0.50）、17.19（95% CI：8.01-36.89）和 0.85（95% CI：0.82-0.88）。对于高级别尿路上皮癌，CLE 的汇总敏感性、特异性、PLR、NLR、DOR 和 AUC 分别为 0.82（95% CI：0.62-0.92）、0.84（95% CI：0.73-0.91）、4.96（95% CI：2.58-9.54）、0.22（95% CI：0.09-0.52）、22.49（95% CI：5.33-94.85）和 0.89（95% CI：0.86-0.91）。