Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis
Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis
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DOI：
10.1016/j.oraloncology.2023.106419
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发表时间：
2023-05-12
期刊：
影响因子：
4.8
通讯作者：
Dhanda，Jagtar
中科院分区：
文献类型：
--
作者：
Higginson，James A.;Breik，Omar;Dhanda，Jagtar
背景头颈鳞状细胞癌 (HNSCC) 手术后的阳性切缘会导致显着的发病率和死亡率。由于采样技术、时间限制和资源要求的限制，现有的术中边缘评估（IMA）技术并未得到广泛应用。我们对现有 IMA 技术在 HNSCC 中的诊断性能进行了荟萃分析，为判断新兴技术提供了基准。方法该研究是根据系统评价和荟萃分析的首选报告项目 (PRISMA) 报告指南进行的。如果研究报告了头颈部鳞状细胞癌手术期间使用的技术的诊断指标，并与永久性组织病理学进行比较，则该研究被纳入其中。筛选、稿件审查和数据提取由多个独立观察员进行。使用双变量随机效应模型估计汇总敏感性和特异性。结果从最初的 2344 篇参考文献中，纳入了 35 项研究进行荟萃分析。计算每组的敏感性 (Sens)、特异性 (Spec)、诊断优势比 (DOR) 和受试者工作特征曲线下面积 (AUROC)（n、Sens、Spec、DOR、AUROC）：冰冻切片 = 13、0.798、0.991、309.8、0.976；肿瘤靶向荧光 (TTF) = 5、0.957、0.827、66.4、0.944；光学技术 = 10, 0.919, 0.855, 58.9, 0.925；触摸印记细胞学 = 3, 0.925, 0.988, 51.1, 0.919;局部染色=4、0.918、0.759、16.4、0.833。结论冰冻切片和TTF具有最佳的诊断性能。冰冻切片受到采样误差的限制。 TTF 显示出希望，但涉及全身性药物的管理。目前这两种药物都没有在临床上广泛使用。新兴技术必须表现出有竞争力的诊断准确性，同时提供快速、可靠、具有成本效益的结果。
BackgroundPositive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged.MethodsThe study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model.ResultsFrom an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833.ConclusionsFrozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.