Key Laboratory of Carcinogenesis and Translational Research, Hepatopancreatobiliary Surgery Department I, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China.
Key Laboratory of Carcinogenesis and Translational Research, Department of Ultrasonography, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China.
Ann Surg Oncol. 2021 Jul;28(7):3763-3773. doi: 10.1245/s10434-020-09365-x. Epub 2020 Nov 27.
The diagnostic accuracy of imaging modalities in colorectal cancer liver metastases (CRLM) has improved in recent years, therefore the role of current imaging techniques needs to be defined.
The aim of this study was to assess the diagnostic performance of magnetic resonance imaging, preoperative imaging (magnetic resonance imaging or computed tomography), intraoperative ultrasound, and contrast-enhanced intraoperative ultrasound in the detection of CRLM.
Eligible trials published before 30 March 2020 were identified from the EMBASE, PubMed, Web of Science, and Cochrane Library databases, and descriptive and quantitative data were extracted. Study quality was evaluated for the identified studies and a random-effects model was used to determine the integrated diagnosis estimation. Meta-regression was implemented to explore the possible contributors to heterogeneity.
Overall, 13 studies were included for analysis, comprising 682 patients with a total of 2303 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio of contrast-enhanced intraoperative ultrasound were 0.94 (95% confidence interval [CI] 0.89-0.97), 0.83 (95% CI 0.67-0.92), and 79 (95% CI 32-196), respectively. The overall weighted area under the curve was 0.96 (95% CI 0.94-0.97). In univariate meta-regression analysis, disappearing liver metastasis, contrast agent, and Kupffer phase were the potent sources of heterogeneity; however, in multivariate meta-regression, no definite variable was the source of the study heterogeneity.
Contrast-enhanced intraoperative ultrasound demonstrated a high sensitivity and specificity for screening CRLM.
近年来，影像学在结直肠癌肝转移（CRLM）中的诊断准确性有所提高，因此需要明确当前影像学技术的作用。
本研究旨在评估磁共振成像、术前影像学（磁共振成像或计算机断层扫描）、术中超声和对比增强术中超声在检测 CRLM 中的诊断性能。
从 EMBASE、PubMed、Web of Science 和 Cochrane Library 数据库中确定了 2020 年 3 月 30 日前发表的合格试验，并提取了描述性和定量数据。对确定的研究进行了研究质量评估，并使用随机效应模型确定了综合诊断估计。实施了元回归以探索异质性的可能来源。
共有 13 项研究纳入分析，包括 682 例患者，共 2303 个肝脏病变。对比增强术中超声的汇总敏感性、特异性和诊断优势比分别为 0.94（95%置信区间 [CI] 0.89-0.97）、0.83（95% CI 0.67-0.92）和 79（95% CI 32-196）。总体加权曲线下面积为 0.96（95% CI 0.94-0.97）。在单变量meta 回归分析中，消失性肝转移、对比剂和库普弗期是异质性的主要来源；然而，在多变量meta 回归中，没有确定的变量是研究异质性的来源。
对比增强术中超声在筛查 CRLM 方面具有较高的敏感性和特异性。
