摘要
目的通过荟萃分析系统评价常规超声、超声造影、超声弹性成像及CT检查单独或者四者中两者联合检查在临床确诊甲状腺癌淋巴结转移中的实际价值。方法检索2006年1月至2023年8月的中英文数据库,筛选出关于超声、超声造影、弹性成像和CT在诊断甲状腺癌淋巴结转移的相关文献。两位学者独立评估文献质量,并使用QUADAS量表进行评分。然后,通过Meta-Disc软件分析单一及联合检查的诊断比值比,进行异质性检验和Meta分析,计算敏感性、特异性、阳性似然比、阴性似然比、诊断比值比、准确性以及ROC曲线下面积(AUC)。最终,通过两两比较计算OR值及P值,评估不同诊断技术及联合应用鉴别甲状腺癌淋巴结转移的诊断效能。结果最终纳入69个诊断性研究,共计病灶30666个。元分析研究表明,超声造影敏感性最高[0.83(0.77~0.87)],常规超声特异性最高[0.84(0.79~0.88)],AUC最高的为超声造影(0.90),超声造影和超声弹性成像准确性较高(分别为0.81、0.80)均高于常规超声(0.77)和CT(0.69),超声造影和超声弹性成像敏感性均高于CT,两者之间差异有统计学意义(均P<0.01);超声造影+超声弹性成像准确性最高,常规超声+超声造影和超声造影+弹性成像均敏感性较高,两者之间差异无统计学意义(P>0.05),但后者特异性最高[0.90(0.88~0.92)],两者之间差异有统计学意义(P<0.01),常规超声+超声造影和超声造影+超声弹性成像敏感性均高于常规超声+CT,两者之间差异有统计学意义(均P<0.05),常规超声+CT特异性最低[0.76(0.70~0.81)]。结论甲状腺癌淋巴结转移的诊断效能以超声造影最高;诊断甲状腺癌淋巴结转移超声新技术较CT诊断价值高,可作为常规超声的补充检查。两种技术结合使用时,超声造影+超声弹性成像准确性最高,超声造影+超声弹性成像与常规超声+超声造影均具有较高敏感性和特异性,两者诊断性能均高于常规超声+超声弹性成像和常规超声+CT,实际临床中当超声弹性成像联合超声造影检查受限,常规超声联合超声造影能有效作为替代手段,提供良好的诊断支持。
Objective To evaluate the practical value of ultrasound,ultrasound new technologies(ultrasound elastography,contrast enhanced ultrasound)and computed tomography(CT)examination alone or the combination of both of the four in the clinical diagnosis of lymph node metastasis of thyroid cancer by meta-analysis system.Methods This study screened relevant literature on ultrasound,new ultrasound technologies,and CT in the diagnosis of lymph node metastasis of thyroid cancer by searching Chinese and English databases from January 2006 to August 2023.Two scholars independently assessed the quality of the literatures and scored them using the QUADAS scale.Then,the diagnostic ratio of single and combined examinations was analyzed by Meta-Disc software,and the heterogeneity test and meta-analysis were performed to calculate the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic ratio,accuracy,and area under curve(AUC).Finally,the diagnostic efficacies of different diagnostic techniques and their combination in identifying lymph node metastasis of thyroid cancer were assessed by calculating OR and P values by two-by-two comparisons.Results Sixty-nine diagnostic studies totaling 30,666 lesions were finally included.The meta-analysis study showed that contrast enhanced ultrasound had the highest sensitivity[0.83(0.77-0.87)],ultrasound specificity was the highest[0.84(0.79-0.88)],the highest AUC was for contrast enhanced ultrasound(0.90),and contrast enhanced ultrasound and ultrasound elastography had high accuracies(0.81,0.80,respectively)both of them were higher than those of ultrasound(0.77)and CT(0.69).Contrast enhanced ultrasound and ultrasound elastography were both more sensitive than CT,with statistically significant differences between them(P<0.01);contrast enhanced ultrasound+ultrasound elastography had the highest accuracy,while ultrasound+contrast enhanced ultrasound and contrast enhanced ultrasound+ultrasound elastography were both more sensitive,with no statistically significant differences between them(P>0.05),but the latter had the highest specificity[0.90(0.88-0.92)],which were statistically significantly different from each other(P<0.05),ultrasound+contrast enhanced ultrasound and contrast enhanced ultrasound+ultrasound elastography had higher sensitivities than ultrasound+CT,which were statistically different from each other(P<0.05),and ultrasound+CT had the lowest specificity[0.76(0.70-0.81)].Conclusions The diagnostic efficacy of thyroid cancer lymph node metastasis is highest with contrast enhanced ultrasound.The new ultrasound technique for diagnosing thyroid cancer lymph node metastasis has a higher diagnostic value than CT,and it can be used as a complementary examination to conventional ultrasound.When the two techniques are used in combination,contrast enhanced ultrasound+ultrasound elastography has the highest accuracy,contrast enhanced ultrasound+ultrasound elastography and ultrasound+contrast enhanced ultrasound both have high sensitivity and specificity,and the diagnostic performance of both is higher than that of ultrasound+ultrasound elastography and ultrasound+CT,and in actual clinical practice when ultrasound elastography combined with contrast enhanced ultrasound is limited in the examination,ultrasound combined with contrast enhanced ultrasound can effectively serve as an alternative means to provide a good diagnostic support.
作者
魏伟
李广涵
董竞方
万宇翔
王湘竹
张波
Wei Wei;Li Guanghan;Dong Jingfang;Wan Yuxiang;Wang Xiangzhu;Zhang Bo(Department of Ultrasound,Chinese Academy of Medical Sciences,Peking Union Medical College,China-Japan Friendship Hospital,Beijing 100029,China;Department of Ultrasound,Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2024年第6期525-537,共13页
Chinese Journal of Ultrasonography
基金
国家自然科学基金(22278449)。
关键词
超声检查
甲状腺癌
甲状腺癌淋巴结转移
CT
超声新技术
Meta分析
Ultrasonography
Thyroid cancer
Thyroid cancer lymph node metastasis
CT
New ultrasound technology
Meta-analysis
