Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China.
Shanghai Key Laboratory of Radiation Oncology, Shanghai, China.
Head Neck. 2024 May;46(5):1210-1223. doi: 10.1002/hed.27713. Epub 2024 Mar 6.
The diagnostic efficacy of the water swallow test (WST) is relatively robust for patients with neurogenic dysphagia; however, its diagnostic performance in identifying dysphagia among patients with HNC varies across studies. Our study aims to assess the diagnostic value of the WST for detecting dysphagia in patients with HNC. Systematic retrieval of studies on the use of WST for screening dysphagia in patients with HNC from databases up to August 1, 2023. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the screening ability of WST for dysphagia. A total of seven articles, encompassing eight study groups, were included, involving the analysis of 691 patients. The meta-analysis results demonstrate that the WST has a combined sensitivity, specificity, positive LR, negative LR, DOR, and AUC for diagnosing dysphagia in patients with HNC of 0.82 (95% CI [0.64, 0.92]), 0.79 (95% CI [0.70, 0.86]), 4.00 (95% CI [2.51, 6.36]), 0.22 (95% CI [0.10, 0.50]), 17.94 (95% CI [5.56, 57.92]), and 0.86 (95% CI [0.83, 0.89]), respectively. Significant heterogeneity was observed among the included studies. Meta-regression analysis showed that the pooled sensitivity of tumor sites and treatment was closely related, while the pooled specificity of treatment and version was closely related. The subgroup analysis showed that the WST's pooled sensitivity for diagnosing dysphagia in patients with nasopharyngeal cancer was 0.40 (95% CI [0.26, 0.56]), with an AUC of 0.50, lower than in other HNC sites. The WST performed better in surgical patients than in those undergoing radiotherapy (RT) or chemoradiotherapy (CRT), with lower sensitivity, specificity, and AUC values of 0.49 (95% CI [0.36, 0.61]), 0.66 (95% CI [0.59, 0.72]), and 0.64, respectively, for RT or CRT patients. The modified WST version showed different specificity values of 0.82 (95% CI [0.75, 0.87]), compared to the regular version of 0.68 (95% CI [0.61, 0.74]). Additionally, Deek's test indicated the absence of publication bias in this study (p = 0.32). The WST demonstrates favorable sensitivity and specificity in detecting dysphagia among patients with HNC. However, the diagnostic value may vary depending on factors such as tumor sites, treatment, and the specific version of the WST used.
水吞咽试验（WST）在诊断神经性吞咽困难方面具有相对可靠的效能；然而，其在识别头颈部癌症（HNC）患者吞咽困难方面的诊断性能在不同研究中存在差异。本研究旨在评估 WST 对头颈部癌症患者吞咽困难的诊断价值。从数据库中系统检索截至 2023 年 8 月 1 日使用 WST 筛查头颈部癌症患者吞咽困难的研究。使用 QUADAS-2 工具对头颈部癌症患者吞咽困难的纳入研究进行质量评估。计算合并敏感性、特异性、阳性似然比（LR）、阴性 LR、诊断比值比（DOR）和受试者工作特征曲线下面积（AUC），以评估 WST 筛查吞咽困难的能力。共纳入 7 篇文章，共 8 个研究组，涉及 691 例患者。Meta 分析结果表明，WST 对 HNC 患者吞咽困难的综合敏感性、特异性、阳性 LR、阴性 LR、DOR 和 AUC 分别为 0.82（95%CI[0.64，0.92]）、0.79（95%CI[0.70，0.86]）、4.00（95%CI[2.51，6.36]）、0.22（95%CI[0.10，0.50]）、17.94（95%CI[5.56，57.92]）和 0.86（95%CI[0.83，0.89]）。纳入的研究存在显著的异质性。Meta 回归分析显示，肿瘤部位和治疗的合并敏感性与肿瘤部位和治疗的 Meta 回归分析密切相关，而治疗和版本的合并特异性与治疗和版本的 Meta 回归分析密切相关。亚组分析显示，WST 对头颈部癌症患者吞咽困难的合并敏感性为 0.40（95%CI[0.26，0.56]），AUC 为 0.50，低于其他 HNC 部位。WST 在手术患者中的表现优于接受放疗（RT）或放化疗（CRT）的患者，其敏感性、特异性和 AUC 值分别为 0.49（95%CI[0.36，0.61]）、0.66（95%CI[0.59，0.72]）和 0.64。RT 或 CRT 患者的特异性值较低，为 0.68（95%CI[0.61，0.74]）。此外，Deek 检验表明本研究不存在发表偏倚（p=0.32）。WST 在检测头颈部癌症患者吞咽困难方面具有良好的敏感性和特异性。然而，诊断价值可能因肿瘤部位、治疗和使用的 WST 特定版本等因素而有所不同。
