Narrow-band imaging bronchoscopy in the detection of premalignant airway lesions: a meta-analysis of diagnostic test accuracy
Narrow-band imaging bronchoscopy in the detection of premalignant airway lesions: a meta-analysis of diagnostic test accuracy
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DOI：
10.1177/1753465815589698
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发表时间：
2015-10-01
影响因子：
4.3
通讯作者：
Musani, Ali I.
中科院分区：
文献类型：
--
作者：
Iftikhar, Imran H.;Musani, Ali I.
目的：自体荧光支气管镜成像和窄带成像都显示出在检测恶性前气道病变方面的希望，每一种都利用不同带宽的光来更好地表征粘膜和粘膜下血管网格。由于先前发表的荟萃分析显示自体荧光支气管镜成像的特异性较差，因此我们专门研究了单独窄带成像和联合自体荧光支气管镜成像检测恶性前气道病变的诊断准确性。方法：在PubMed和Medline中广泛搜索符合条件的研究后，提取的数据用加权平均值汇总。构建对称总结-受者工作特征曲线，对结果进行定量总结。采用I-2指数评价研究异质性。结果：对8项窄带成像研究数据的分析显示，合并敏感性为0.80[95%可信区间（CI）： 0.77-0.83]，合并特异性为0.84 （95% CI: 0.81-0.86）。根据窄带成像数据计算的汇总-接收机工作特性曲线下面积为0.908（标准误差0.01）。窄带成像诊断优势比为31.49 （95% CI: 12.17-81.45）。窄带显像和自身荧光显像支气管镜联合使用的研究数据显示，合并后的敏感性、特异性、曲线下面积和诊断优势比分别为0.86 （95% CI: 0.82-0.89）、0.75 （95% CI: 0.71-0.79）、0.964（标准误差0.05）和27.96 （95% CI: 3.04-257.21）。结论：我们的研究结果表明，与自体荧光支气管镜成像相比，窄带成像在评估气管癌前病变方面具有更高的敏感性、特异性和诊断优势比。然而，结合自身荧光成像支气管镜和窄带成像并不能显著改善测试性能特征。
Objectives: Both autofluorescence imaging bronchoscopy and narrow-band imaging have shown promise in the detection of premalignant airway lesions, each by utilizing different bandwidths of lights for better characterization of the mucosal and submucosal vascular grid. Since previously published meta-analyses have shown poor specificity of autofluorescence imaging bronchoscopy, we specifically studied the diagnostic accuracy of narrow-band imaging alone and in combination with autofluorescence imaging bronchoscopy in the detection of premalignant airway lesions.Methods: After an extensive search of eligible studies from PubMed and Medline, extracted data were pooled with weighted averages. Symmetrical summary-receiver operating characteristic curves were constructed to summarize the results quantitatively. Study heterogeneity was assessed by the I-2 index.Results: Analysis of data from eight studies on narrow-band imaging showed a pooled sensitivity of 0.80 [95% confidence interval (CI): 0.77-0.83] and a pooled specificity of 0.84 (95% CI: 0.81-0.86). Summary-receiver operating characteristic curves from the data on narrow-band imaging calculated an area-under-the-curve of 0.908 (standard error 0.01). The diagnostic odds ratio of narrow-band imaging was 31.49 (95% CI: 12.17-81.45). Data from studies where narrow-band imaging and autofluorescence imaging bronchoscopy were used together showed a pooled sensitivity, specificity, area-under-the-curve and diagnostic odds ratios of 0.86 (95% CI: 0.82-0.89), 0.75 (95% CI: 0.71-0.79), 0.964 (standard error 0.05) and 27.96 (95% CI: 3.04-257.21), respectively.Conclusions: Our findings indicate that in the evaluation of premalignant airway lesions, narrow-band imaging has a higher sensitivity, specificity and diagnostic odds ratios compared with autofluorescence imaging bronchoscopy. However, combining autofluorescence imaging bronchoscopy and narrow-band imaging does not significantly improve test performance characteristics.