Department of Radiology, Royal Price Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
Department of Ear, Nose and Throat Surgery, Concord Hospital, Concord, NSW, Australia.
Neuroradiology. 2022 Aug;64(8):1471-1481. doi: 10.1007/s00234-022-02941-w. Epub 2022 Apr 30.
Endoscopic biopsy is recommended for diagnosis of nasopharyngeal carcinoma (NPC). A proportion of lesions are hidden from endoscopic view but detected with magnetic resonance imaging (MRI). This systematic review and meta-analysis investigated the diagnostic performance of MRI for detection of NPC.
An electronic search of twelve databases and registries was performed. Studies were included if they compared the diagnostic accuracy of MRI to a reference standard (histopathology) in patients suspected of having NPC. The primary outcome was accuracy for detection of NPC. Random-effects models were used to pool outcomes for sensitivity, specificity, and positive and negative likelihood ratio (LR). Bias and applicability were assessed using the modified QUADAS-2 tool.
Nine studies were included involving 1736 patients of whom 337 were diagnosed with NPC. MRI demonstrated a pooled sensitivity of 98.1% (95% CI 95.2-99.3%), specificity of 91.7% (95% CI 88.3-94.2%), negative LR of 0.02 (95% CI 0.01-0.05), and positive LR of 11.9 (95% CI 8.35-16.81) for detection of NPC. Most studies were performed in regions where NPC is endemic, and there was a risk of selection bias due to inclusion of retrospective studies and one case-control study. There was limited reporting of study randomization strategy.
This study demonstrates that MRI has a high pooled sensitivity, specificity, and negative predictive value for detection of NPC. MRI may be useful for lesion detection prior to endoscopic biopsy and aid the decision to avoid biopsy in patients with a low post-test probability of disease.
内镜活检被推荐用于诊断鼻咽癌（NPC）。一部分病变从内镜检查中隐藏，但可通过磁共振成像（MRI）检测到。本系统评价和荟萃分析旨在调查 MRI 对 NPC 检测的诊断性能。
对 12 个数据库和注册处进行了电子检索。如果研究比较了 MRI 与疑似 NPC 患者的参考标准（组织病理学）的诊断准确性，则纳入研究。主要结局是 NPC 的检测准确性。使用随机效应模型汇总敏感性、特异性、阳性和阴性似然比（LR）的结果。使用修改后的 QUADAS-2 工具评估偏倚和适用性。
纳入了 9 项研究，共涉及 1736 名患者，其中 337 名被诊断为 NPC。MRI 显示，检测 NPC 的汇总敏感性为 98.1%（95%CI 95.2-99.3%），特异性为 91.7%（95%CI 88.3-94.2%），阴性 LR 为 0.02（95%CI 0.01-0.05），阳性 LR 为 11.9（95%CI 8.35-16.81）。大多数研究在 NPC 流行地区进行，由于纳入了回顾性研究和一项病例对照研究，存在选择偏倚的风险。研究随机化策略的报告有限。
本研究表明，MRI 对 NPC 的检测具有较高的汇总敏感性、特异性和阴性预测值。MRI 可能有助于在内镜活检前检测病变，并有助于在疾病后验概率较低的患者中决定避免活检。
