Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: A systematic review
Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: A systematic review
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DOI：
10.1111/j.1572-0241.2006.00467.x
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发表时间：
2006-03-01
影响因子：
9.8
通讯作者：
Duca, P
中科院分区：
文献类型：
--
作者：
Colli, A;Fraquelli, M;Duca, P
背景和目的：在慢性肝病患者中，超声扫描（US）、螺旋计算机断层扫描（CT）、磁共振成像（MRI）和甲胎蛋白（AFP）诊断肝细胞癌（HCC）的准确性从未被系统评估过，本系统综述针对这一问题。相关的横断面研究，以切除的肝脏或切除的节段的病理学检查、局灶性病变的活检作为参考标准，和/或一段时间的随访，使用MEDLINE、EMBASE、科克伦图书馆和CancerLit确定。使用随机效应模型计算合并的灵敏度、特异性和似然比（LR）。结果：14项美国研究的汇总估计值为60%，（95% CI 44-76）敏感性，97%（95% CI 95-98）特异性，18 LR+（95% CI 8-37）和0.5 LR-（95% CI 0.4-0.6）; 10例CT检查的敏感性为68%（95% CI 55-80），特异性93%（95% CI 89-96），LR+ 6（95% CI 3-12），LR- 0.4（95% CI 0.3-0.6）; 9项MRI研究的敏感性为81%（95%CI 70-91），特异性为85%（95%CI 77-93），LR+ 3.9（95%CI 2-7）和LR- 0.3（95%CI 0.2-0.5）。AFP的敏感性和特异性变化很大，这不能完全归因于阈值效应的不同截止levels.CONCLUSIONS：美国是高度特异性的，但不够敏感，检测肝癌在许多肿瘤或支持一个有效的监测计划。CT的操作特点与MRI相似，MRI更敏感。需要高质量的前瞻性研究来确定AFP的实际诊断作用。
BACKGROUND AND AIM: In patients with chronic liver disease, the accuracy of ultrasound scan (US), spiral computed tomography (CT), magnetic resonance imaging (MRI), and alpha-fetoprotein (AFP) in diagnosing hepatocellular carcinoma (HCC) has never been systematically assessed, and present systematic review was aimed at this issue.METHODS: Pertinent cross-sectional studies having as a reference standard pathological examinations of the explanted liver or resected segment(s), biopsies of focal lesion(s), and/or a period of follow-up, were identified using MEDLINE, EMBASE, Cochrane Library, and CancerLit. Pooled sensitivity, specificity, and likelihood ratios (LR) were calculated using the random effect model. Summary receiver operating characteristic (SROC) curve and predefined subgroup analyses were made when indicated.RESULTS: The pooled estimates of the 14 US studies were 60% (95% CI 44-76) for sensitivity, 97% (95% CI 95-98) for specificity, 18 (95% CI 8-37) for LR+, and 0.5 (95% CI 0.4-0.6) for LR-; for the 10 CT studies sensitivity was 68% (95% CI 55-80), specificity 93% (95% CI 89-96), LR+ 6 (95% CI 3-12),and LR- 0.4 (95% CI 0.3-0.6); for the nine MRI studies sensitivity was 81% (95% CI 70-91), specificity 85% (95% CI 77-93), LR+ 3.9 (95% CI 2-7), and LR- 0.3 (95% CI 0.2-0.5). The sensitivity and specificity of AFP varied widely, and this could not be entirely attributed to the threshold effect of the different cutoff levels used.CONCLUSIONS: US is highly specific but insufficiently sensitive to detect HCC in many cirrhotics or to support an effective surveillance program. The operative characteristics of CT are comparable, whereas MRI is more sensitive. High-quality prospective studies are needed to define the actual diagnostic role of AFP.