超声造影与超声弹性成像对乳腺良恶性肿块诊断价值的Meta分析  

Contrast-enhanced ultrasonography and ultrasound elastography in diagnosis of benign and malignant breast lumps:a Meta-analysis

作　　者：唐才莉[1] 冯敏[1] 罗志远[1] 宋朝芳[1] 邹正霖[1] TANG Caili FENG Min LUO Zhiyuan SONG Chaofang ZOU Zhenglin(Department of Ultrasound, Luzhou People＇ s Hospital, Sichuan 646000, Chin)

机构地区：[1]四川省泸州市人民医院超声科,646000

出　　处：《临床超声医学杂志》2017年第3期164-169,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的系统对比评价超声造影(CEUS)与超声弹性成像(UE)技术在乳腺良恶性肿块鉴别诊断中的临床价值。方法系统检索PubMed、EMBASE、Cochrane Library、CNKI、VIP、CBM及万方等数据库,纳入以CEUS与UE技术分别鉴别诊断同一组乳腺肿块良恶性的研究,由2位研究员独立进行文献筛选、资料提取及方法学质量评价。采用STATA 14.0软件检测异质性;双变量混合效应模型对其敏感性、特异性、阳性似然比、阴性似然比及诊断比值比进行合并分析;绘制汇总受试者工作特征曲线(SROC)图,计算曲线下面积(AUROC);绘制Fagan图和似然比点状图,进行敏感性和漏斗图分析。结果共纳入17篇文献,共计2460个乳腺肿块。CEUS与UE对乳腺恶性肿块诊断的合并敏感性和合并特异性分别为0.85(95%CI:0.81~0.89)、0.83(95%CI:0.79~0.86)和0.87(95%CI:0.83~0.90)、0.86(95%CI:0.81~0.90);SROC曲线下面积分别为0.93(95%CI:0.90~0.95)、0.90(95%CI:0.87~0.93),二者诊断效能比较差异均有统计学意义(均P<0.05)。各研究稳定性较好,未见明显发表偏倚(P>0.05)。结论 CEUS对乳腺肿块良恶性鉴别诊断效能较UE高,但两者对乳腺肿块良恶性的诊断均有重要意义,将成为乳腺超声诊断的重要发展方向。Objective To systematically and comparatively evaluate the clinical value of contrast--enhanced uhrasonography （CEUS） and ultrasound elastography （UE） in differential diagnosis of benign and malignant breast lumps. Methods Databases including PubMed,EMBASE,Cochrane Library,CNKI,VIP,CBM and WanFang were electronically searched for differential diagnosis research reports of benign and malignant breast lumps by CEUS and UE in the same group of breast lumps,two reviewers independently screened literature,extracted data,and assessed the methodological quality,the heterogeneity was detected by STATA 14.0 software, according to the bivariate mixed effects model, the sensitivity, specificity,positive and negative likelihood ratio and diagnostic odds ratio were meta analyzed, the summary receiver operating characteristic （SROC） curves, Fagan graphs and the likelihood ratio point maps were produced, the area under the curves （AUROC） were also calculated, the analysis of sensitivity was performed and publication bias was analyzed with Deek funnel plot. Results A total of 17 studies（2460 lumps） were included. The pooled sensitivity and specificity were 0.85（95%CI：0.81-0.89） ,0.83（95%CI：0.79-0.86）, and 0.87（95%CI： 0.83 -0.90）, 0.86 （ 95% CI：0.81-0.90 ）, the area under the curves were 0.93 （ 95% CI： 0.90 ~0.95 ）, 0.90 （ 95% Ch 0.87 ~0.93 ）, respectively.There was significant difference of diagnostic efficiency between the methods（P〈0.05 ）. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Deeks funnel plot suggested the publication bias was not significant（P〉0.05）. Conclusion In the diagnosis of benign and malignant breast lumps, the diagnostic efficiency of CEUS is better than UE,however,both of them have high clinical value in diagnosis. It will become an important development direction of ultrasound diagnosis of breast lump.

关 键 词：超声检查 造影剂 弹性成像 乳腺肿块 良恶性 META分析 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]