超声内镜引导下细针穿刺活检（EUS-FNA）和超声内镜引导下经支气管针吸活检（EUS-B-FNA）在肺癌患者左肾上腺转移瘤诊断中的应用：一项系统评价和荟萃分析

Performance of EUS-FNA and EUS-B-FNA for the diagnosis of left adrenal glands metastases in patients with lung cancer: A systematic review and meta-analysis.

作者信息

Moretti Antonio, Kovacevic Bojan, Vilmann Peter, Annema Jouke T, Korevaar Daniël A

机构信息

Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands; Unit of Respiratory Diseases, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.

Gastro Unit, Division of Endoscopy, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.

出版信息

Lung Cancer. 2023 Dec;186:107391. doi: 10.1016/j.lungcan.2023.107391. Epub 2023 Oct 5.

DOI:10.1016/j.lungcan.2023.107391

PMID:37827042

Abstract

OBJECTIVES

For diagnosing left adrenal gland metastasis in lung cancer, clinical guidelines recommend to perform EUS, but EUS-B (EUS using an EBUS-scope) is increasingly being used. We evaluated the diagnostic performance of both procedures.

MATERIALS AND METHODS

We did a systematic review (PROSPERO, CRD42023416205) and searched MEDLINE and EMBASE on 04-July-2023 for studies evaluating EUS and/or EUS-B in diagnosing left adrenal gland metastases in adults with (suspected) lung cancer. Outcomes were: (1) ability to visualize the left adrenal gland, (2) ability to sample (in those with successful visualization and in whom sampling was attempted), (3) ability to obtain adequate material (in those with successful sampling), (4) malignancy detection rate (in those with successful sampling), and (5) remaining risk of malignancy (in those with a negative EUS(-B)-FNA and undergoing a reference standard). We performed random-effects meta-analyses.

RESULTS

We included 19 studies (EUS: n = 11, EUS-B: n = 6, both: n = 2), covering 1712 patients. All studies had high (n = 18) or unclear (n = 1) risk of bias (QUADAS-2). Average ability to visualize the left adrenal gland was 0.94 (95 %CI 0.82-0.98; n = 7 studies). Average ability to sample was 1.00 (95 %CI 0.99-1.00; n = 9). Average ability to obtain adequate material was 0.96 (95 %CI 0.93-0.98; n = 18). Average malignancy detection rate was 0.42 (95 %CI 0.34-0.49; n = 18). Remaining risk of malignancy was 0.07 (95 %CI 0.04-0.12; n = 8). Ability to visualize was slightly higher for EUS (0.99; 95 %CI 0.90-1.00) than EUS-B (0.84; 95 %CI 0.70-0.92; p = 0.025), but the other performance characteristics were similar. No major complications were reported.

CONCLUSION

Both EUS and EUS-B have good performance and are safe for left adrenal gland analysis in patients with lung cancer, but the number of high-quality studies is limited and further well-constructed prospective studies are needed.

摘要

目的

对于肺癌左肾上腺转移的诊断，临床指南推荐进行超声内镜检查（EUS），但超声内镜引导下支气管超声检查（EUS-B，即使用超声支气管镜的EUS）的应用越来越广泛。我们评估了这两种检查方法的诊断性能。

材料与方法

我们进行了一项系统评价（国际前瞻性系统评价注册库，CRD42023416205），并于2023年7月4日在MEDLINE和EMBASE数据库中检索评估EUS和/或EUS-B用于诊断（疑似）肺癌成年患者左肾上腺转移的研究。结局指标包括：（１）观察左肾上腺的能力；（２）取材能力（在成功观察且尝试取材的患者中）；（３）获取足够标本的能力（在成功取材的患者中）；（４）恶性肿瘤检出率（在成功取材的患者中）；（５）恶性肿瘤残留风险（在EUS（-B）-FNA结果为阴性且接受参考标准检查的患者中）。我们进行了随机效应荟萃分析。

结果

我们纳入了19项研究（EUS：11项，EUS-B：6项，两者均有：2项），涵盖1712例患者。所有研究的偏倚风险均为高（18项）或不清楚（1项）（QUADAS-2）。观察左肾上腺的平均能力为0.94（95%CI 0.82-0.98；7项研究）。取材的平均能力为1.00（95%CI 0.99-1.00；9项研究）。获取足够标本的平均能力为0.96（95%CI 0.93-0.98；18项研究）。恶性肿瘤平均检出率为0.42（95%CI 0.34-0.49；18项研究）。恶性肿瘤残留风险为0.07（95%CI 0.04-0.12；8项研究）。EUS观察的能力（0.99；95%CI 0.90-1.00）略高于EUS-B（0.84；95%CI 0.70-0.92；p = 0.025），但其他性能特征相似。未报告重大并发症。