功能影像在头颈部癌诊断价值的循证医学研究
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摘要
目的:头颈部癌有很高的倾向性出现远处转移和第二原发癌,早期诊断对于准确的M分期、最优治疗的选择、比较进展期疾病的不同治疗方案是十分必要的。全身PET和PET-CT扫描是头颈部癌治疗前早期诊断远处转移或第二原发癌的有前景的工具,我们拟通过此次meta分析以评价PET和PET-CT在头颈部癌初始M分期方面的价值。
方法:系统检索2000年1月1日至2009年9月31日在EMBASE,PUBMED及Cochrane图书馆系统评价数据库有关PET或PET-CT确定头颈部癌M分期价值的研究。两人独立检索文献和提取数据。利用Meta-Disc软件分别计算二者总的灵敏度、特异度、诊断优势比、阳性似然比、阴性似然比、SROC曲线及Q*值。
结果: 12篇文献符合纳入条件被选择,包括8个PET研究(795例患者)和7个PET-CT研究(797例患者)。纳入研究中的1445例患者中有209例(14.4%)出现远处转移或第二原发癌。汇总的全身PET的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及95%的可信区间分别为0.848 (0.776–0.905), 0.952 (0.933–0.967), 107.23 (59.255–194.04), 17.401 (12.161– 24.899),和0.170 (0.116–0.249)。汇总的全身PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及95%的可信区间分别为0.875 (0.787–0.936), 0.950 (0.931–0.964), 174.24(77.109–393.72), 16.653(11.996– 23.117),和0.141 (0.083– 0.238)。PET-CT的Q*值(0.9409)较PET的(0.9154)高,但二者无明显统计学差异(Z=0.76,p>0.05)。
结论:全身PET-CT和PET在确定头颈部癌初始M分期方面均具有较高价值;二者诊断准确性相当,但PET-CT有比PET提高的趋势;一个阴性的全身PET或PET-CT扫描结果不能单独作为拒绝远处转移癌或第二原发癌的指标。
目的: FDG PET/PET-CT是有前景的预计头颈部癌放疗后行颈清扫术必要性的影像工具。我们拟通过此次meta分析以评价FDG PET/PET-CT预计头颈部癌放疗后行颈清扫术必要性的价值。
方法:计算机检索从1990年1月到2010年1月的相关PET和PET-CT原始文献。金标准为病理分析和/或临床和影象随访。两人独立搜索文献和提取数据。利用Bivariate模型汇总计算出PET/PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比,并绘制HSROC曲线探讨其总的诊断效能。
结果: 13篇文献符合纳入条件被选择,包括14个PET/PET-CT研究。纳入文献中的755例患者中有111例患者(14.7%)出现放疗后颈部淋巴结复发或残留。汇总的PET/PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及其95%可信区间分别为0.876 (0.759-0.940),0.891 (0.777-0.951 ),57.712(13.465 -247.355),8.047(3.547-18.257)和0.139(0.065-0.298)。
结论: FDG-PET/PET-CT在预计头颈部癌放疗后行颈清扫术必要性方面具有较高的价值。一个阴性的FDG-PET/PET-CT扫描结果不能单独作为拒绝头颈部癌放疗后颈清扫术的指标。
Purpose:Head and neck cancer have a high propensity for developing distant metastasis and a second primary cancer . Early diagnosis is essential for precise M staging, optimal management, and accurate comparison of protocol efficacies in patients with advanced disease.Whole-body PET and PET-CT are promising tools in the early diagnosis of distant metastasis or a second primary cancer in patients with head and neck cancer before treatment. We conducted a meta-analysis to evaluate the value of whole-body PET and PET-CT in initial M staging of head and neck cancer.
Methods:Studies about the accuracy of PET or PET-CT in determining initial M staging of head and neck cancer were systematically searched in the MEDLINE, EMBASE, and the Cochrane Database of Systematic Review from January 1, 2000 to September 31, 2009. Two reviewers independently searched articles and extracted data. A software called“Meta-DiSc”was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristic (SROC) curves, and the Q* index, respectively.
Results: Twelve articles met our inclusion criteria and were selected, including seven PET-CT studies (797 patients) and eight PET studies (795 patients).209 (14.4%) of 1445 eiligble patient in the selected studies have distant metastasis or a second primary cancer. The pooled sensitivity, specificity and DOR, PLR, and NLR with 95% of confidence interval of whole-body PET were 0.848(0.776–0.905), 0.952 (0.933–0.967), 107.23 (59.255–194.04), 17.401 (12.161–24.899), and 0.170 (0.116–0.249), respectively. The pooled sensitivity, specificity, DOR, PLR, and NLR with 95% of confidence interval of whole -body PET-CT were 0.875 (0.787–0.936), 0.950 (0.931–0.964), 174.24(77.109–393.72), 16.653 (11.996–23.117), and 0.141 (0.083– 0.238), respectively.The Q* index estimates for PET-CT (0.9409) were not significantly higher than for PET (0.9154) (p>0.05).
Conclusions: Whole-body PET-CT and PET have higher diagnostic value in determining initial M staging of head and neck cancer; Both have similar diagnostic accuracy. But PET-CT tends to have higher accuracy than PET. A negative examination result of PET or PET-CT cann’t be used alone as a justification to rule out distant metastasis or a second primary cancer.
Purpose:FDG-PET and PET-CT are promising imaging tools in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. We conducted a meta-analysis to evaluate the value of FDG PET/PET-CT in prediction of necessity for neck dissection for head and neck cancer after radiotherapy.
Methods:A computer search about PET/PET-CT original articles from January 1990 to January 2010 was conducted. The reference standard was histop–athologic analysis and/or close clinical and imaging follow-up. Two reviewers independently searched articles and extracted data. Sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were pooled using the bivariate model. Hierarchical summary receiver operating characteristic (HSROC) curves were also used to summarize overall test performance.
Results:Thirteen articles met our inclusion criteria and were selected, including fourteen PET/PET-CT studies. 111 (14.7%) of 745 eiligble patient in the selected studies have the residual or recurrence of lymph nodes after radiotherapy. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio with 95% of confidence interval for PET/PET-CT was 0.876 (0.759-0.940),0.891(0.777-0.951), 57.712(13.465 -247.355),8.047(3.547 -18.257) and 0.139(0.065-0.298), respectively.
Conclusions: FDG PET/PET-CT had higher accuracy in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. A negative examination result of PET or PET-CT couldn’t be used alone as a justification to rule out neck dissection for head and neck cancer after radiotherapy.
方法:系统检索2000年1月1日至2009年9月31日在EMBASE,PUBMED及Cochrane图书馆系统评价数据库有关PET或PET-CT确定头颈部癌M分期价值的研究。两人独立检索文献和提取数据。利用Meta-Disc软件分别计算二者总的灵敏度、特异度、诊断优势比、阳性似然比、阴性似然比、SROC曲线及Q*值。
结果: 12篇文献符合纳入条件被选择,包括8个PET研究(795例患者)和7个PET-CT研究(797例患者)。纳入研究中的1445例患者中有209例(14.4%)出现远处转移或第二原发癌。汇总的全身PET的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及95%的可信区间分别为0.848 (0.776–0.905), 0.952 (0.933–0.967), 107.23 (59.255–194.04), 17.401 (12.161– 24.899),和0.170 (0.116–0.249)。汇总的全身PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及95%的可信区间分别为0.875 (0.787–0.936), 0.950 (0.931–0.964), 174.24(77.109–393.72), 16.653(11.996– 23.117),和0.141 (0.083– 0.238)。PET-CT的Q*值(0.9409)较PET的(0.9154)高,但二者无明显统计学差异(Z=0.76,p>0.05)。
结论:全身PET-CT和PET在确定头颈部癌初始M分期方面均具有较高价值;二者诊断准确性相当,但PET-CT有比PET提高的趋势;一个阴性的全身PET或PET-CT扫描结果不能单独作为拒绝远处转移癌或第二原发癌的指标。
目的: FDG PET/PET-CT是有前景的预计头颈部癌放疗后行颈清扫术必要性的影像工具。我们拟通过此次meta分析以评价FDG PET/PET-CT预计头颈部癌放疗后行颈清扫术必要性的价值。
方法:计算机检索从1990年1月到2010年1月的相关PET和PET-CT原始文献。金标准为病理分析和/或临床和影象随访。两人独立搜索文献和提取数据。利用Bivariate模型汇总计算出PET/PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比,并绘制HSROC曲线探讨其总的诊断效能。
结果: 13篇文献符合纳入条件被选择,包括14个PET/PET-CT研究。纳入文献中的755例患者中有111例患者(14.7%)出现放疗后颈部淋巴结复发或残留。汇总的PET/PET-CT的敏感性、特异性、诊断优势比、阳性似然比、阴性似然比及其95%可信区间分别为0.876 (0.759-0.940),0.891 (0.777-0.951 ),57.712(13.465 -247.355),8.047(3.547-18.257)和0.139(0.065-0.298)。
结论: FDG-PET/PET-CT在预计头颈部癌放疗后行颈清扫术必要性方面具有较高的价值。一个阴性的FDG-PET/PET-CT扫描结果不能单独作为拒绝头颈部癌放疗后颈清扫术的指标。
Purpose:Head and neck cancer have a high propensity for developing distant metastasis and a second primary cancer . Early diagnosis is essential for precise M staging, optimal management, and accurate comparison of protocol efficacies in patients with advanced disease.Whole-body PET and PET-CT are promising tools in the early diagnosis of distant metastasis or a second primary cancer in patients with head and neck cancer before treatment. We conducted a meta-analysis to evaluate the value of whole-body PET and PET-CT in initial M staging of head and neck cancer.
Methods:Studies about the accuracy of PET or PET-CT in determining initial M staging of head and neck cancer were systematically searched in the MEDLINE, EMBASE, and the Cochrane Database of Systematic Review from January 1, 2000 to September 31, 2009. Two reviewers independently searched articles and extracted data. A software called“Meta-DiSc”was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristic (SROC) curves, and the Q* index, respectively.
Results: Twelve articles met our inclusion criteria and were selected, including seven PET-CT studies (797 patients) and eight PET studies (795 patients).209 (14.4%) of 1445 eiligble patient in the selected studies have distant metastasis or a second primary cancer. The pooled sensitivity, specificity and DOR, PLR, and NLR with 95% of confidence interval of whole-body PET were 0.848(0.776–0.905), 0.952 (0.933–0.967), 107.23 (59.255–194.04), 17.401 (12.161–24.899), and 0.170 (0.116–0.249), respectively. The pooled sensitivity, specificity, DOR, PLR, and NLR with 95% of confidence interval of whole -body PET-CT were 0.875 (0.787–0.936), 0.950 (0.931–0.964), 174.24(77.109–393.72), 16.653 (11.996–23.117), and 0.141 (0.083– 0.238), respectively.The Q* index estimates for PET-CT (0.9409) were not significantly higher than for PET (0.9154) (p>0.05).
Conclusions: Whole-body PET-CT and PET have higher diagnostic value in determining initial M staging of head and neck cancer; Both have similar diagnostic accuracy. But PET-CT tends to have higher accuracy than PET. A negative examination result of PET or PET-CT cann’t be used alone as a justification to rule out distant metastasis or a second primary cancer.
Purpose:FDG-PET and PET-CT are promising imaging tools in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. We conducted a meta-analysis to evaluate the value of FDG PET/PET-CT in prediction of necessity for neck dissection for head and neck cancer after radiotherapy.
Methods:A computer search about PET/PET-CT original articles from January 1990 to January 2010 was conducted. The reference standard was histop–athologic analysis and/or close clinical and imaging follow-up. Two reviewers independently searched articles and extracted data. Sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were pooled using the bivariate model. Hierarchical summary receiver operating characteristic (HSROC) curves were also used to summarize overall test performance.
Results:Thirteen articles met our inclusion criteria and were selected, including fourteen PET/PET-CT studies. 111 (14.7%) of 745 eiligble patient in the selected studies have the residual or recurrence of lymph nodes after radiotherapy. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio with 95% of confidence interval for PET/PET-CT was 0.876 (0.759-0.940),0.891(0.777-0.951), 57.712(13.465 -247.355),8.047(3.547 -18.257) and 0.139(0.065-0.298), respectively.
Conclusions: FDG PET/PET-CT had higher accuracy in prediction of necessity for neck dissection in head and neck cancer after radiotherapy. A negative examination result of PET or PET-CT couldn’t be used alone as a justification to rule out neck dissection for head and neck cancer after radiotherapy.
引文
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1. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005[J]. CA Cancer J Clin, 2005, 55(1): 10–30.
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