系统评价ADC值术前对肾癌亚型及透明细胞肾癌类病理分级的诊断价值  

Systematic evaluation of the preoperative diagnostic value of ADC value in subtype differentiation of renal cell carcinoma and pathological grading of clear cell renal cell carcinoma

作　　者：任安伟 何继强 何杰 阳明[1] 杨敏[1] 王飞 REN An-wei;HE Ji-qiang;HE Jie(Department of Medical Imaging,Luzhou People's Hospital,Sichuan 646000,China)

机构地区：[1]泸州市人民医院医学影像科,四川646000 [2]南充市高坪区人民医院放射科,四川637100

出　　处：《放射学实践》2022年第7期857-864,共8页Radiologic Practice

摘　　要：目的:系统评价ADC值术前预测透明细胞肾癌(ccRCC)、乳头状肾癌(pRCC)、嫌色细胞肾癌(chRCC)及ccRCC病理分级的可行性。方法:由2位研究人员独立检索PubMed、Web of science、Cochrane Library、Embase、知网及万方数据库中扩散加权成像诊断肾癌亚型及ccRCC病理分级的研究,时间从建库至2021年3月1日。采用QUADAS-2量表进行质量评价,采用RevMan5.3及stata12软件进行汇总分析。结果:最终纳入26篇文献(中文8篇,英文18篇),共1635例肾癌,各研究不存在发表偏倚(P>0.1)。ccRCC的ADC值明显高于pRCC(SMD=1.17,95%CI:0.73~1.61,P<0.05)及chRCC(SMD=0.86,95%CI:0.15~1.57,P<0.05),而pRCC与chRCC的组间差异无统计学意义(SMD=-0.29,95%CI:-1.04~0.45,P>0.1);低级别ccRCC的ADC值明显高于高级别ccRCC(SMD=0.91,95%CI:0.62~1.21,P<0.05)。ADC值术前鉴别ccRCC与非ccRCC的汇总敏感度、特异度、诊断比值比和集成受试者操作特征(SROC)曲线下面积分别为0.83、0.83、23.12和0.8909,术前鉴别高、低级别ccRCC的汇总敏感度、特异度、诊断比之比和SROC曲线下面积分别为0.80、0.73、10.25和0.8269。敏感性分析表明各研究稳定性良好;亚组分析提示文献类型(中文vs英文,P=0.04)可能为异质性来源。结论:ccRCC的ADC值明显高于pRCC及chRCC,而pRCC与chRCC的组间差异无统计学意义,ADC值可作为一种无创术前预测肾癌亚型ccRCC及ccRCC类病理分级的检测方法。Objective:To systematically evaluate the feasibility of ADC value for preoperative prediction of clear cell renal cell carcinoma(ccRCC),papillary renal cell carcinoma(pRCC),chromophobe renal cell carcinoma(chRCC)and pathological grading of ccRCC.Methods:PubMed,Web of science,Cochrane Library,EMBASE,CNKI and Wanfang databases were independently searched by two researchers for studies published until March 1,2021,that reported diffusion weighted imaging in preoperative diagnosis of subtype differentiation of renal cell carcinoma and the pathological grading of ccRCC.QUADAS-2 scale was used for quality evaluation.RevMan5.3 and stata12 software were used for summary analysis.Results:A total of 26 up-to-standard literatures(8 in Chinese and 18 in English)were included,including 1635 cases of RCC.There was no publication bias in each study(P>0.1).The ADC value of ccRCC was significantly higher than that of pRCC(SMD=1.17,95%CI:0.73~1.61,P<0.05)and chRCC(SMD=0.86,95%CI:0.15~1.57,P<0.05),but there was no significant difference between pRCC and chRCC(SMD=-0.29,95%CI:-1.04~0.45,P>0.1).The ADC value of low-grade ccRCC was significantly higher than that of high-grade ccRCC(SMD=0.91,95%CI:0.62~1.21,P<0.05).The pooled sensitivity,specificity,diagnostic odds ratio and the area under SROC curve of ADC value for preoperative discrimination of ccRCC and non-ccRCC were 0.83,0.83,23.12 and 0.8909,respectively.And the pooled sensitivity,specificity,diagnostic odds ratio and the area under summary receiver operating characteristic(SROC)curve of ADC value for preoperative discrimination of high and low grade CCRCC were 0.80,0.73,10.25 and 0.8269,respectively.The sensitivity analysis showed that the stability of each study was good,and the subgroup analysis identified that the type of literature(Chinese VS English,P=0.04)might be the source of heterogeneity.Conclusion:The ADC value of ccRCC was significantly higher than that of pRCC and chRCC,but there was no significant difference between pRCC and chRCC.The ADC value could be used as a

关 键 词：肾癌 亚型 病理分级 扩散加权成像 荟萃分析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.11[医药卫生—诊断学] R-05[医药卫生—临床医学]