中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
33期
2715-2719
,共5页
外阴癌%前哨淋巴结%诊断%荟萃分析
外陰癌%前哨淋巴結%診斷%薈萃分析
외음암%전초림파결%진단%회췌분석
Vulval cancer%Sentinel lymph node%Diagnosis%Meta-analysis
目的 系统评价前哨淋巴结活检(SLNB)用于早期外阴鳞状细胞癌淋巴结转移诊断的临床价值.方法 以1990至2014为年限,检索Cochrane Library临床试验数据库、PubMed数据库、中国期刊全文数据库(CNKI)、万方等数据库及相关期刊中关于SLNB在早期外阴鳞状细胞癌中应用的文献,按照纳入和排除标准对文献进行筛选,使用Meta Disc 1.4软件进行荟萃分析.结果 通过检索获得文献共2 459篇,其中符合纳入标准文献29篇,包含英文文献28篇,中文文献1篇;23项研究为前瞻性,6项为回顾性,共包含1 371例早期外阴鳞癌患者.各项研究报道的SLNB用于早期外阴癌淋巴结转移诊断的敏感性为66.7％～100％,特异性均为100％.各项纳入研究结果无明显异质性(I2=12.8％,P =0.270),使用固定效应模型进行合并的SLNB敏感性和特异性分别为0.94(95％ CI:0.91～0.96)和1.00(95％ CI:0.99 ～1.00),计算汇总受试者操作特性(SROC)曲线下面积为0.987 0.亚组分析显示使用单一示踪剂和联合示踪剂的SLNB合并敏感性分别为0.92(95％ CI:0.85 ～0.97)和0.94(95％ CI:0.91～0.97);在使用“超分期”病理技术和常规病理技术的研究中,合并敏感性分别为0.93(95％ CI:0.90～0.96)和0.97(95％ CI:0.90～1.00).结论 SLNB对早期外阴鳞状细胞癌患者淋巴结转移具有很高的诊断价值,不同的SLNB技术具有相似的敏感性和特异性.
目的 繫統評價前哨淋巴結活檢(SLNB)用于早期外陰鱗狀細胞癌淋巴結轉移診斷的臨床價值.方法 以1990至2014為年限,檢索Cochrane Library臨床試驗數據庫、PubMed數據庫、中國期刊全文數據庫(CNKI)、萬方等數據庫及相關期刊中關于SLNB在早期外陰鱗狀細胞癌中應用的文獻,按照納入和排除標準對文獻進行篩選,使用Meta Disc 1.4軟件進行薈萃分析.結果 通過檢索穫得文獻共2 459篇,其中符閤納入標準文獻29篇,包含英文文獻28篇,中文文獻1篇;23項研究為前瞻性,6項為迴顧性,共包含1 371例早期外陰鱗癌患者.各項研究報道的SLNB用于早期外陰癌淋巴結轉移診斷的敏感性為66.7％～100％,特異性均為100％.各項納入研究結果無明顯異質性(I2=12.8％,P =0.270),使用固定效應模型進行閤併的SLNB敏感性和特異性分彆為0.94(95％ CI:0.91～0.96)和1.00(95％ CI:0.99 ～1.00),計算彙總受試者操作特性(SROC)麯線下麵積為0.987 0.亞組分析顯示使用單一示蹤劑和聯閤示蹤劑的SLNB閤併敏感性分彆為0.92(95％ CI:0.85 ～0.97)和0.94(95％ CI:0.91～0.97);在使用“超分期”病理技術和常規病理技術的研究中,閤併敏感性分彆為0.93(95％ CI:0.90～0.96)和0.97(95％ CI:0.90～1.00).結論 SLNB對早期外陰鱗狀細胞癌患者淋巴結轉移具有很高的診斷價值,不同的SLNB技術具有相似的敏感性和特異性.
목적 계통평개전초림파결활검(SLNB)용우조기외음린상세포암림파결전이진단적림상개치.방법 이1990지2014위년한,검색Cochrane Library림상시험수거고、PubMed수거고、중국기간전문수거고(CNKI)、만방등수거고급상관기간중관우SLNB재조기외음린상세포암중응용적문헌,안조납입화배제표준대문헌진행사선,사용Meta Disc 1.4연건진행회췌분석.결과 통과검색획득문헌공2 459편,기중부합납입표준문헌29편,포함영문문헌28편,중문문헌1편;23항연구위전첨성,6항위회고성,공포함1 371례조기외음린암환자.각항연구보도적SLNB용우조기외음암림파결전이진단적민감성위66.7％～100％,특이성균위100％.각항납입연구결과무명현이질성(I2=12.8％,P =0.270),사용고정효응모형진행합병적SLNB민감성화특이성분별위0.94(95％ CI:0.91～0.96)화1.00(95％ CI:0.99 ～1.00),계산회총수시자조작특성(SROC)곡선하면적위0.987 0.아조분석현시사용단일시종제화연합시종제적SLNB합병민감성분별위0.92(95％ CI:0.85 ～0.97)화0.94(95％ CI:0.91～0.97);재사용“초분기”병리기술화상규병리기술적연구중,합병민감성분별위0.93(95％ CI:0.90～0.96)화0.97(95％ CI:0.90～1.00).결론 SLNB대조기외음린상세포암환자림파결전이구유흔고적진단개치,불동적SLNB기술구유상사적민감성화특이성.
Objective To systematically review the clinical value of sentinel lymph node biopsy (SLNB) in diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva.Methods Cochrane library,biomedical database (EMbase),PubMed,China national knowledge internet (CNKI),Wang Fang database,《Gynecologic Oncology》,《National Medical Journal of China》and 《Chinese Journal of Obstetrics and Gynecology》 were searched for literatures from 1990 to 2014 concerning SLNB application in early-stage vulvar squamous cell carcinoma.Literatures were filtrated according to inclusive and exclusive criteria.Meta Disc 1.4 software was used for meta-analysis.Results A total of 2 459 literatures were obtained,out of which 29 were eligible for analysis,including 28 in English and 1 in Chinese.Twenty-three studies were prospective and 6 were retrospective,including 1 371 patients with early-stage squamous cell carcinoma of vulva.The sensitivity of SLNB for diagnosis of lymph node metastasis in early-stage vulvar cancer ranged from 66.7％ to 100％,and the specificity were 100％ in all studies.No significant heterogeneity was found among the results of enrolled studies (I2 =12.8％,P =0.270).The data were pooled by fixed effect model,and the pooled sensitivity and specificity were 0.94 (95％ CI:0.91-0.96) and 1.00 (95％ CI:0.99-1.00),respectively.The calculated area under curve (AUC) of summarized Receiver Operating Characteristic (ROC) was 0.987 0.Subgroup analysis showed that the pooled sensitivity of SLNB were 0.92 (95 ％ CI:0.85-0.97) and 0.94 (95 ％ CI:0.91-0.97) in studies using single and combined tracers,respectively,and that they were 0.93 (95％ CI:0.90-0.96) and 0.97 (95％ CI:0.90-1.00) in studies with and without ultra-staging techniques,respectively.Conclusions SLNB is a highly accurate technique for diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva.The sensitivity and specificity are similar in SLNBs using different techniques.
