Radić Mislav, Đogaš Hana, Gelemanović Andrea, Jurić Petričević Slavica, Škopljanac Ivan, Radić Josipa
Internal Medicine Department, Rheumatology, Allergology, and Clinical Immunology Division, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital of Split, 21000 Split, Croatia.
Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia.
Diagnostics (Basel). 2023 Apr 16;13(8):1429. doi: 10.3390/diagnostics13081429.
The aim of the current systematic review was to summarize and evaluate the overall advantages of lung ultrasonography (LUS) examination using high-resolution computed tomography (HRCT) as a reference standard in assessing the presence of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients.
Databases PubMed, Scopus, and Web of Science were searched for studies evaluating LUSs in ILD assessments including SSc patients on 1 February 2023. In assessing risk of bias and applicability, the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used. A meta-analysis was performed and the mean specificity, sensitivity, and diagnostic odds ratio (DOR) with a 95% confidence interval (CI) were obtained. In addition, in a bivariate meta-analysis, the summary receiver operating characteristic (SROC) curve area was additionally calculated.
Nine studies with a total of 888 participants entered the meta-analysis. A meta-analysis was also performed without one study that used pleural irregularity to assess the diagnostic accuracy of LUSs using B-lines (with a total of 868 participants). Overall sensitivity and specificity did not differ significantly, with only the analysis of the B-lines having a specificity of 0.61 (95% CI 0.44-0.85) and a sensitivity of 0.93 (95% CI 0.89-0.98). The diagnostic odds ratio of univariate analysis of the eight studies using the B-lines as a criterion for ILD diagnosis was 45.32 (95% CI 17.88-114.89). The AUC value of the SROC curve was 0.912 (and 0.917 in consideration of all nine studies), which indicates high sensitivity and a low false-positive rate for the majority of the included studies.
LUS examination proved to be a valuable tool in discerning which SSc patients should receive additional HRCT scans to detect ILD and therefore reduces the doses of ionizing radiation exposure in SSc patients. However, further studies are needed to achieve consensus in scoring and the evaluation methodology of LUS examination.
本系统评价的目的是总结和评估以高分辨率计算机断层扫描（HRCT）为参考标准的肺部超声检查（LUS）在评估系统性硬化症（SSc）患者间质性肺疾病（ILD）存在情况时的总体优势。
于2023年2月1日检索了PubMed、Scopus和Web of Science数据库，以查找评估LUS在包括SSc患者在内的ILD评估中的研究。在评估偏倚风险和适用性时，使用了诊断准确性研究质量评估修订工具（QUADAS-2）。进行了荟萃分析，并获得了平均特异性、敏感性和诊断比值比（DOR）以及95%置信区间（CI）。此外，在双变量荟萃分析中，还计算了汇总接受者操作特征（SROC）曲线面积。
共有9项研究、888名参与者纳入荟萃分析。还进行了一项不包括一项使用胸膜不规则性评估LUS使用B线诊断准确性的研究的荟萃分析（共868名参与者）。总体敏感性和特异性无显著差异，仅B线分析的特异性为0.61（95%CI 0.44-0.85），敏感性为0.93（95%CI 0.89-0.98）。以B线为ILD诊断标准的8项研究的单变量分析诊断比值比为45.32（95%CI 17.88-114.89）。SROC曲线的AUC值为0.912（考虑所有9项研究时为0.917），这表明大多数纳入研究具有高敏感性和低假阳性率。
LUS检查被证明是一种有价值的工具，可用于识别哪些SSc患者应接受额外的HRCT扫描以检测ILD，从而减少SSc患者的电离辐射暴露剂量。然而，需要进一步研究以在LUS检查的评分和评估方法上达成共识。
