Optimal Modality for Detecting Distant Metastasis in Primary Nasopharyngeal Carcinoma during Initial Staging: A Systemic Review and Meta-analysis of 1774 Patients.
Optimal Modality for Detecting Distant Metastasis in Primary Nasopharyngeal Carcinoma during Initial Staging: A Systemic Review and Meta-analysis of 1774 Patients.
复制标题
原发性鼻咽癌初始分期检测远处转移的最佳方式：对 1774 名患者的系统回顾和荟萃分析
DOI：
10.7150/jca.18361
复制
发表时间：
2017
影响因子：
3.9
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Xu C;Zhang Y;Peng L;Liu X;Li WF;Sun Y;Zhang X;Lin XP;Liu Q;Ma J
目的：比较两种常用于检测原发性鼻咽癌（NPC）远处转移的方法的诊断性能：18 F-氟脱氧葡萄糖（18 F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）和常规检查（CWU）。方法：全面检索并纳入所有与主题相关的研究。我们确定了各项研究的敏感性和特异性，计算了阴性和阳性似然比（分别为LR-和LR+），并构建了汇总的受试者工作特征曲线。此外，我们通过分析报告这些诊断方法对相同患者的结果的研究，比较了PET/CT和CWU的诊断性能。结果：PET/CT（1474例患者）和CWU（1329例患者）的合并敏感性和特异性分别为85.7%和98.1%，38.0%和97.6%。在PET/CT和CWU的头对头比较中（1029例患者），PET/CT显示出显著更高的灵敏度（83.7% vs. 40.1%，P < 0.001）和较低的LR-（0.169 vs.0.633，P < 0.001）;合并特异性（97.7% vs. 97.8%，P = 0.892）或LR+（36.416 vs. 16.845，P = 0.149）无显著差异。PET/CT优于CWU的主要原因是对骨转移的诊断性能更好。然而，PET/CT在检测肝转移方面的敏感性不佳。敏感性分析显示，与原始分析相比，PET/CT的敏感性和LR-相对较差。结论：PET/CT对原发性NPC远处转移的检出率上级优于CWU。然而，PET/CT在检测肝转移方面的功效仍需要进一步优化。
Purpose: To compare the diagnostic performance of two modalities commonly used for detecting distant metastasis in primary nasopharyngeal carcinoma (NPC): 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and conventional work-ups (CWUs). Methods: All topic-related studies were comprehensively searched and included. We determined sensitivities and specificities across studies, calculated negative and positive likelihood ratios (LR- and LR+, respectively), and constructed summary receiver operating characteristic curves. Moreover, we compared the diagnostic performance of PET/CT and CWUs by analyzing studies that reported the results of these diagnostic methods on the same patients. Results: The pooled sensitivity and specificity were 85.7% and 98.1% for PET/CT (1474 patients), and 38.0% and 97.6% for CWUs (1329 patients). In the head-to-head comparison of PET/CT and CWUs (1029 patients), PET/CT showed a significantly higher sensitivity (83.7% vs. 40.1%, P < 0.001) and lower LR- (0.169 vs. 0.633, P < 0.001) than CWUs on a per-patient basis; no significant difference was observed in pooled specificity (97.7% vs. 97.8%, P = 0.892) or LR+ (36.416 vs. 16.845, P = 0.149). The superiority of PET/CT over CWUs was due mainly to the better diagnostic performance on bone metastasis. However, suboptimal sensitivity of PET/CT was reported in the aspect of detection of liver metastasis. Sensitivity analyses showed relatively poor sensitivity and LR- of PET/CT compared to the original analysis. Conclusions: PET/CT was superior to CWUs in detecting distant metastasis in primary NPC. However, the efficacy of PET/CT in detecting liver metastasis still requires further optimization.