Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies.
Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies.
复制标题
哨兵淋巴结活检在早期口服鳞状细胞癌中的诊断功效：66项研究的荟萃分析。
DOI：
10.1371/journal.pone.0170322
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Peng H
中科院分区：
文献类型：
--
作者：
Liu M;Wang SJ;Yang X;Peng H
前哨淋巴结活检（SLNB）对早期口腔鳞状细胞癌（OSCC）的诊断价值仍存在争议。本荟萃分析旨在评估SLNB在临床颈部阴性T1-2 OSCC中的诊断价值。在PubMed、Embase、Web of Science、科克伦图书馆和ClinicalTrials中对截至2016年9月11日发表的相关文献进行了系统性文献检索，并检查了合格研究的参考文献列表。汇总不同研究的数据，以估计前哨淋巴结（SLN）的识别率、敏感性和阴性预测值。绘制受试者工作特征曲线（SROC），计算SROC曲线下面积（AUC），评价总体诊断效能。阈值效应用斯皮尔曼相关系数进行评估。使用Q检验和I2统计量检验研究间异质性。鉴于不同研究特征对SLN诊断有效性的影响更大，进行了亚组分析。采用Deeks漏斗图不对称性检验评价发表偏倚。通过逐个省略研究并比较随机效应模型和固定效应模型的汇总结果来评估敏感性分析。所有分析均使用Review Manager（版本5.3.5）、Meta-DiSc（版本1.4）、Comprehensive Meta Analysis（版本2.0）和STATA（版本12）进行。本荟萃分析纳入了66项研究，包括3566例cT 1 - 2N 0 OSCC患者。合并SLN识别率为96.3%（95%CI：95.3%-97.0%）。合并灵敏度为0.87（95% CI：0.85-0.89），合并阴性预测值为0.94（95% CI：0.93-0.95），AUC为0.98（95% CI：0.97-0.99）。亚组分析表明，SLN评估与免疫组化（IHC）实现了显着更高的灵敏度比没有IHC。这项荟萃分析表明，SLNB对cT 1 - 2N 0口腔鳞状细胞癌具有较高的诊断准确性，是选择性颈清扫术的理想替代方法。此外，使用IHC可以显着提高SLNB诊断早期OSCC的敏感性。
The diagnostic efficacy of sentinel lymph node biopsy(SLNB) in early oral squamous cell carcinoma(OSCC) still remains controversial. This meta-analysis was conducted to assess the diagnostic value of SLNB in clinically neck-negative T1-2 OSCC. A systematic literature search for relevant literature published up to September 11, 2016 was conducted in PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials, and the reference lists of eligible studies were examined. Data from different studies were pooled to estimate the summary sentinel lymph node(SLN) identification rate, sensitivity, negative predictive value. Summary receiver operator characteristic curve(SROC) was plotted and area under the SROC curve (AUC) was calculated to evaluate the overall diagnostic efficacy. Threshold effect was assessed with use of the spearman correlation coefficient. Between-study heterogeneity was tested using the Q tests and the I2 statistics. Subgroup analyses were conducted in view of the greater effect of different study characteristics on diagnostic efficacy of SLN. Deeks’ funnel plot asymmetry test was performed to evaluate publication bias. Sensitivity analysis was evaluated through omitting studies one by one and comparing the pooled results of random-effects model and fixed-effects model. All analyses were performed using Review Manager (version 5.3.5), Meta-DiSc (version 1.4), Comprehensive Meta Analysis (version 2.0) and STATA (version 12). 66 studies comprising 3566 patients with cT1-2N0 OSCC were included in this meta-analysis. The pooled SLN identification rate was 96.3%(95% CI: 95.3%-97.0%). The pooled sensitivity was 0.87 (95% CI: 0.85–0.89), pooled negative predictive value was 0.94 (95% CI: 0.93–0.95), and AUC was 0.98 (95% CI: 0.97–0.99). Subgroup analyses indicated that SLN assessment with immunohistochemistry(IHC) achieved a significantly higher sensitivity than without IHC. This meta-analysis suggests that SLNB has a high diagnostic accuracy in cT1-2N0 oral squamous cell carcinoma, and is an ideal alternative to elective neck dissection. Furthermore, the use of IHC can significantly improve SLNB diagnostic sensitivity for early OSCC.