Reuter Simon, Naur Therese Maria Henriette, Clementsen Paul Frost, Bodtger Uffe
Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Eur Clin Respir J. 2019 Feb 6;6(1):1565803. doi: 10.1080/20018525.2019.1565803.
The scientific background in expert-opinion papers for recommending Computed Tomography (CT) in unilateral pleural exudates is based on studies including patients with other findings than unilateral pleural effusions or selected patients undergoing thoracoscopy. Therefore, we performed a systematic review investigating the sensitivity of CT for predicting malignancy in patients with unilateral, non-transudative, pleural effusions. A search strategy was developed with the assistance of a medical information specialist at our university library. We searched PubMed/MEDLINE, EMBASE and Cochrane Library, ClinicalTrials.gov and articles citing the included studies. No date restrictions were applied (the first included paper was published in 2001 (1)), and only literature in English was included. We used the Quality Assessment of Diagnostic Accuracy Studies 2 for bias assessment. We registered the protocol at PROSPERO (CRD42018094830). Five studies were included, two prospective and three retrospective, all performed in Western Europe. No study reported diagnostic values for patients with unilateral, non-transudative pleural effusions only; one study did for unilateral pleural effusions. In the remaining studies, most patients had unilateral effusions and non-transudative effusions. Patients were primarily males and >70 years. All but one study found a high incidence of malignancy, dominated by malignant pleural mesothelioma. All studies were limited by risk of bias and applicability, predominantly regarding study population, pretests and index test. The current evidence supporting the sensitivity of CT for predicting malignancy in unilateral pleural effusions (both non-transudative and all types of effusion) is very low and did not allow meta-analysis. Standardization of patient population and CT protocol may facilitate conclusions of futures studies.
在关于推荐计算机断层扫描（CT）用于单侧胸腔积液的专家意见论文中，其科学背景基于一些研究，这些研究纳入的患者除了单侧胸腔积液外还有其他表现，或者是经过挑选的接受胸腔镜检查的患者。因此，我们进行了一项系统评价，以研究CT对单侧、非漏出性胸腔积液患者恶性肿瘤预测的敏感性。在我校图书馆医学信息专家的协助下制定了检索策略。我们检索了PubMed/MEDLINE、EMBASE和Cochrane图书馆、ClinicalTrials.gov以及引用纳入研究的文章。未设日期限制（纳入的第一篇论文发表于2001年（1）），仅纳入英文文献。我们使用诊断准确性研究质量评估2进行偏倚评估。我们在PROSPERO（CRD42018094830）上注册了该方案。纳入了五项研究，两项前瞻性研究和三项回顾性研究，均在西欧进行。没有研究仅报告单侧、非漏出性胸腔积液患者的诊断价值；一项研究报告了单侧胸腔积液患者的诊断价值。在其余研究中，大多数患者有单侧积液且为非漏出性积液。患者主要为男性且年龄大于70岁。除一项研究外，所有研究均发现恶性肿瘤发生率较高，主要为恶性胸膜间皮瘤。所有研究均受偏倚风险和适用性的限制，主要涉及研究人群、预试验和索引试验。目前支持CT对单侧胸腔积液（非漏出性和所有类型积液）恶性肿瘤预测敏感性的证据非常少，无法进行荟萃分析。患者人群和CT方案的标准化可能有助于未来研究得出结论。
