钼靶、超声和MRI对乳腺肿块诊断价值的Meta分析  

A Meta-analysis of the value of mammography, ultrasound and MRI in the diagnosis of breast tumors

作　　者：陈君[1,2] 王小飞[3] 张蕾[4] 强永乾[1] 

机构地区：[1]西安交通大学第一附属医院影像科,陕西西安710061 [2]西安市第四医院影像科 [3]西安市儿童医院影像科 [4]西安交通大学第二附属医院影像科

出　　处：《实用放射学杂志》2016年第4期531-535,共5页Journal of Practical Radiology

摘　　要：目的 应用Meta分析法评价钼靶、超声和磁共振成像（MRI）对乳腺肿块的诊断价值。方法 中文文献主要从中国知网（CNKI）、中国生物医学文献数据库（CBM）及重庆维普（VIP）数据库中检索，英文文献主要从荷兰医学文摘（EMBASE OvidSP）、PubMed及The Cochrane Library数据库中检索，检索乳腺肿块诊断中与钼靶、超声和MRI相关的文献，评价所有纳入研究的文献质量并提取相关信息，运用Meta-disc 1.4 软件进行Meta分析，将综合受试者工作特征曲线（SROC）图用Review Manager 5.3软件绘制，并计算曲线下面积（AUC）。结果 钼靶＋超声＋MRI和MRI的诊断效能均明显比钼靶、超声高（P〈0.05）；是否依据BI-RADS诊断标准影响着钼靶研究异质性来源，患者的平均年龄影响着超声研究间异质性来源，各协变量均不会影响到MRI回归分析显示的研究间异质性来源；钼靶的敏感度76%（95%CI：0.73-0.79）、特异度72%（95%CI：0.69-0.75）、诊断比值比（DOR）为8.19（95%CI：5.27-12.75）；超声的敏感度85%（95%CI：0.82-0.87）、特异度70%（95%CI：0.67-0.73）、DOR为11.09（95%CI：6.10-20.16）；MRI的敏感度95%（95%CI：0.93-0.96）、特异度72%（95%CI：0.69-0.75）、DOR为64.69（95%CI：27.67-152.48）；SROC AUC：钼靶82.0%、超声88.5%、MRI 97.4%、钼靶＋超声＋MRI 98.3%。结论 钼靶、超声及MRI对乳腺肿块均有较高诊断价值，以钼靶＋超声＋MRI 3项联合对乳腺肿块诊断效能最高。Objective To investigate the value of mammography （MAM）, ultrasound （US） and MRI in the diagnosis of breast tumors using a Meta-analysis. Methods A systematic search of relevant literatures was done from CNKI, CBM, VIP, EMBASE OvidSP, PubMed and The Cochrane Library databases. Some related literatures about MAM,US and MRI in the diagnosis of breast tumors and the quality was evaluated, and the available information was extracted. The Meta-analysis was then performed by a Meta-disc 1.4 software, and a Review Manager 5.3 software was used to calculate the summary receiver operating characteristic curves and the area under the curve. Results The diagnostic effect of the MAMa-US＋ MRI was significantly higher than that of mammography or ultrasound （P〈0.05）. The MAM study heterogeneity among sources was affected by whether it based on BI-RADS diagnostic criteria, and US study heterogeneity was affected by average age of patients. However, the MRI heterogeneity between studies displayed by regression analysis was not affected by each covariate. The diagnostic sensitivity and specificity were 76% （95%CI：0. 73-0. 79） and 72% （95%CI：0. 69-0. 75） for MAM,85%% （95%CI：0.82-0. 87） and 70% （95%CI：0. 67-0. 73） for US,and 95% （95%CI：0. 93--0. 96） and 72% （95%CI：0. 69-0. 75） for MRI,respectively. And the area under curve （AUC） of summary receiver operating characteristic （SROC） curve was 82.0% ,88. 5% or 97.4%, respectively. Moreover, the AUC of combined three methods together was 98.3%. Conclusion The value of MAM,US and MRI in diagnosis of breast tumor is higher, and the highest one exists when the combined three methods together are used.

关 键 词：钼靶 超声 磁共振成像 乳腺肿块 

分 类 号：R445.1[医药卫生—影像医学与核医学] R445.2[医药卫生—诊断学]