疑似胆道疾病诊断试验敏感性和特异性的修订估计值。

Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease.

作者信息

Shea J A, Berlin J A, Escarce J J, Clarke J R, Kinosian B P, Cabana M D, Tsai W W, Horangic N, Malet P F, Schwartz J S

机构信息

Department of Medicine, University of Pennsylvania, Philadelphia.

出版信息

Arch Intern Med. 1994 Nov 28;154(22):2573-81.

PMID:7979854

Abstract

BACKGROUND

The purpose of this study was to estimate the sensitivity and specificity of diagnostic tests for gallstones and acute cholecystitis.

METHODS

All English-language articles published from 1966 through 1992 about tests used in the diagnosis of biliary tract disease were identified through MEDLINE. From 1614 titles, 666 abstracts were examined and 322 articles were read to identify 61 articles with information about sensitivity and specificity. Application of exclusion criteria based on clinical and methodologic criteria left 30 articles for analysis. Cluster-sampling methods were adapted to obtain combined estimates of sensitivities and specificities. Adjustments were made to estimates that were biased because the gold standard was applied preferentially to patients with positive test results.

RESULTS

Ultrasound has the best unadjusted sensitivity (0.97; 95% confidence interval, 0.95 to 0.99) and specificity (0.95; 95% confidence interval, 0.88 to 1.00) for evaluating patients with suspected gallstones. Adjusted values are 0.84 (0.76 to 0.92) and 0.99 (0.97 to 1.00), respectively. Adjusted and unadjusted results for oral cholecystogram were lower. Radionuclide scanning has the best sensitivity (0.97; 95% confidence interval, 0.96 to 0.98) and specificity (0.90; 95% confidence interval, 0.86 to 0.95) for evaluating patients with suspected acute cholecystitis; test performance is unaffected by delayed imaging. Unadjusted sensitivity and specificity of ultrasound in evaluating patients with suspected acute cholecystitis are 0.94 (0.92 to 0.96) and 0.78 (0.61 to 0.96); adjusted values are 0.88 (0.74 to 1.00) and 0.80 (0.62 to 0.98).

CONCLUSIONS

Ultrasound is superior to oral cholecystogram for diagnosing cholelithiasis, and radionuclide scanning is the test of choice for acute cholecystitis. However, sensitivities and specificities are somewhat lower than commonly reported. We recommend estimates that are midway between the adjusted and unadjusted values.

摘要

背景

本研究旨在评估胆结石及急性胆囊炎诊断试验的敏感性和特异性。

方法

通过医学文献数据库检索1966年至1992年间发表的所有关于用于诊断胆道疾病的试验的英文文章。从1614个标题中筛选出666篇摘要，并阅读322篇文章以确定61篇包含敏感性和特异性信息的文章。根据临床和方法学标准应用排除标准后，剩余30篇文章用于分析。采用整群抽样方法获得敏感性和特异性的综合估计值。对因金标准优先应用于试验结果阳性患者而存在偏差的估计值进行了调整。

结果

在评估疑似胆结石患者时，超声检查具有最佳的未调整敏感性（0.97；95%置信区间为0.95至0.99）和特异性（0.95；95%置信区间为0.88至1.00）。调整后的值分别为0.84（0.76至'0.92）和0.99（0.97至1.00）。口服胆囊造影的调整后和未调整结果较低。放射性核素扫描在评估疑似急性胆囊炎患者时具有最佳的敏感性（0.97；95%置信区间为0.96至0.98）和特异性（0.90；95%置信区间为0.86至0.95）；检查性能不受延迟成像的影响。超声检查在评估疑似急性胆囊炎患者时的未调整敏感性和特异性分别为0.94（0.92至0.96）和0.78（0.61至0.96）；调整后的值分别为0.88（0.74至1.00）和0.80（0.62至0.98）。