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PET/CT对宫颈癌淋巴结转移诊断价值的Meta分析

田金徽, 李金龙, 葛龙, 王婧, 张明霞, 石芳毓, 王小虎, 张红

田金徽, 李金龙, 葛龙, 王婧, 张明霞, 石芳毓, 王小虎, 张红. PET/CT对宫颈癌淋巴结转移诊断价值的Meta分析[J]. 肿瘤防治研究, 2015, 42(03): 270-276. DOI: 10.3971/j.issn.1000-8578.2015.03.013
引用本文: 田金徽, 李金龙, 葛龙, 王婧, 张明霞, 石芳毓, 王小虎, 张红. PET/CT对宫颈癌淋巴结转移诊断价值的Meta分析[J]. 肿瘤防治研究, 2015, 42(03): 270-276. DOI: 10.3971/j.issn.1000-8578.2015.03.013
TIAN Jinhui, LI Jinlong, GE Long, WANG Jing, ZHANG Mingxia, SHI Fangyu, WANG Xiaohu, ZHANG Hong. Diagnostic Value of PET/CT for Metastatic Lymph Nodes in Cervical Cancer Patients: A Meta-analysis[J]. Cancer Research on Prevention and Treatment, 2015, 42(03): 270-276. DOI: 10.3971/j.issn.1000-8578.2015.03.013
Citation: TIAN Jinhui, LI Jinlong, GE Long, WANG Jing, ZHANG Mingxia, SHI Fangyu, WANG Xiaohu, ZHANG Hong. Diagnostic Value of PET/CT for Metastatic Lymph Nodes in Cervical Cancer Patients: A Meta-analysis[J]. Cancer Research on Prevention and Treatment, 2015, 42(03): 270-276. DOI: 10.3971/j.issn.1000-8578.2015.03.013

PET/CT对宫颈癌淋巴结转移诊断价值的Meta分析

详细信息
    作者简介:

    田金徽(1978-),男,博士,主要从事循证医学与放射肿瘤学的研究

    通讯作者:

    王小虎,E-mail: xhwanggansu@163.com

  • 中图分类号: R737.33; R814.42; R817.4

Diagnostic Value of PET/CT for Metastatic Lymph Nodes in Cervical Cancer Patients: A Meta-analysis

  • 摘要: 目的 采用Meta分析方法评价PET/CT在宫颈癌淋巴结转移诊断中的临床价值。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase.com、维普、万方、中国期刊全文数据库、中国生物医学文献数据库,并辅以手工检索,检索日期截止2013年7月11日,获取PET/CT诊断宫颈癌淋巴结转移的相关文献。2名研究者严格按照纳入排除标准独立地筛选文献、提取资料,依据QUADAS(quality assessment of diagnostic accuracy studies)工具进行文献质量评价,用Meta-Disc 1.4和Stata 12.0软件对其敏感度(SEN)、特异性(SPE)、阳性似然比(+LR)、阴性似然比(-LR)、诊断比值比(DOR)进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线(SROC),并计算曲线下面积(AUR)。结果 检索获得1 006条记录,最终纳入26篇文献,其中英文文献23篇,中文文献3篇。Meta分析结果显示:SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC,验前概率和验后概率分别为0.73(95%CI:0.70~0.76)、0.96(95%CI:0.95~0.96),7.86(95%CI:5.30~11.65)、0.35(95%CI:0.28~0.45)、31.63(95%CI:17.17~58.25)、0.92(95%CI:0.89~0.94)、20%和73%。结论 PET/CT对比手术后病理诊断宫颈癌淋巴结转移有中度的敏感度和较好的特异性,可作为宫颈癌淋巴结转移的诊断方法之一。

     

    Abstract: Objective To evaluate the diagnostic value of PET/CT for metastatic lymph nodes in cervical cancer patients by Meta-analysis. Methods We systematically searched PubMed, EMBASE, Cochrane Library, Embase.com, VIP, CNKI, Wangfang databases, and CBM from inception to July 11, 2013 to identify relative studies of PET/CT for metastatic lymph nodes in cervical cancer patients. Study selection and data extraction were performed by two independent reviewers, and quality assessment of diagnostic accuracy studies (QUADAS) items were used to evaluate the quality of included studies. Meta-disc 1.4 and Stata12.0 software were used to synthesize the data, such as sensitivity(SEN), specificity(SPE), positive likelihood ratio(+LR), negative likelihood ratio(-LR), diagnosis odds ration(DOR), etc., for heterogeneity test, to draw summary receiver operating characteristic(SROC) and calculate the area under the curve(AUR). Results A total of 26 studies met the eligible criteria, 23 studies for English and 3 studies for Chinese. Meta-analysis results showed that SEN, SPE, +LR, -LR, DOR, AUR, pre-test probability, and post-test probability of PET/CT for metastatic lymph nodes in patients with cervical cancer were 0.73(95%CI: 0.70-0.76), 0.96(95%CI:0.95-0.96), 7.86(95%CI: 5.30-11.65), 0.35(95%CI: 0.28-0.45), 31.63(95%CI: 17.17-58.25), 0.92(95%CI:0.89-0.94), 20%, and 73%, respectively. Conclusion A moderate sensitivity and higher specificity were found in PET/CT for metastatic lymph nodes in patients with cervical cancer. PET/CT could be used as one of the effective diagnostic techniques to diagnose metastatic lymph nodes from cervical cancer.

     

  • [1] Parkin DM, Bray F, Ferlay J, et al. Estimating the world cancer burden:Globocan 2000[J]. Int J Cancer, 2001, 94(2): 153-6.
    [2] Tanaka Y, Sawada S, Murata T. Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix[J]. Acta Radiol Oncol, 1984, 23 (6): 455-9.
    [3] Downey GO, Potish RA, Adcock LL, et al. Pretreatment surgical staging in cervical carcinoma:therapeutic efficacy of pelvic lymph node resection[J]. Am J Obster Gynecol, 1989, 160(5 Pt 1): 10 55-61.
    [4] Potish RA, Twiggs LB, Okagaki T, et al. Therapeutic implications of the natural history of advanced cervical cancer as defined by pretreatment surgical staging [J].Cancer, 1985, 56(4): 956-60.
    [5] Chou HH, Chang HP, Lai CH, et al. (18)F-FDG PET in Stage 1B/ IIB cervical adenocarcinoma/ adenosquamous carcinoma [J]. Eur J Nucl Med Mol Imaging, 2010, 37(4): 728-35.
    [6] Grigsby PW. PET/CT imaging to guide cervical cancer therapy[J]. Future Oncol, 2009, 5(7): 953-8.
    [7] Dolezelova H, Slampa P, Ondrova B, et al. The impact of PET with 18F-FDG in radio therapy treatment planning and in the prediction inpatient swith cervix carcinoma: results of pilot study[J]. Neoplasma, 2008, 55(5): 437-41.
    [8] Leeflang MM, Deeks JJ, Gatsonis C, et al. Systematic reviews of diagnostic test accuracy[J]. Ann Intern Med, 2008, 149(12): 88 9-97.
    [9] Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews[J]. BMC Med Res Methodol, 2003, 3: 25.
    [10] Rose PG, Adler LP, Rodriguez M, et al. Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study[J]. J Clin Oncol, 1999, 17(1): 41-5.
    [11] Narayan K, Hicks RJ, Jobling T, et al. A comparison of MRI and PET scanning in surgically staged loco‐regionally advanced cervical cancer: Potential impact on treatment[J]. Int J Gynecol Cancer, 2001, 11(4): 263-71.
    [12] Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, et al. Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET[J]. Radiology, 2001, 218(3): 776-82.
    [13] Yeh LS, Hung YC, Shen YY, et al. Detecting para-aortic lymph nodal metastasis by positron emission tomography of 18 F-fluorodeoxyglucose in advanced cervical cancer with negative magnetic resonance imaging findings[J]. Oncol Rep, 20 02, 9(6): 1289-92.
    [14] Belhocine T, Thille A, Fridman V, et al. Contribution of wholebody 18 FDG PET imaging in the management of cervical cancer[J]. Gynecol Oncol, 2002, 87(1): 90-7.
    [15] Ryu SY, Kim MH, Choi SC, et al. Detection of early recurrence with 18F-FDG PET in patients with cervical cancer[J]. J Nucl Med, 2003, 44(3): 347-52.
    [16] Havrilesky LJ, Wong TZ, Secord AA, et al. The role of PET scanning in the detection of recurrent cervical cancer[J]. Gynecol Oncol, 2003, 90(1): 186-90.
    [17] Li n WC, Hu n g YC, Ye h LS , e t a l . Us e f u l n e s s o f (18) F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings[J].Gynecol Oncol, 20 03, 89(1): 73-6.
    [18] Lv SM. Clinical value of positron emission tomography and computed tomography (PET/CT) in the monitoring gynecologic malignant tumors[D]. Shandong University, 2005. [吕世明. 正电 子发射体层显像 (PET/CT) 检测妇科恶性肿瘤的临床价值[D]. 山东大学, 2005.]
    [19] Park W, Park YJ, Huh SJ, et al. The usefulness of MRI and PET imaging for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer[J]. Jpn J Clin Oncol, 2005, 35(5): 260-4.
    [20] Roh JW, Seo SS, Lee S, et al. Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study[J]. Eur J Cancer, 2005, 41(14): 2086-92.
    [21] Choi HJ, Roh JW, Seo SS, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/ computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study[J]. Cancer, 2006, 106(4): 914-22.
    [22] Sironi S, Buda A, Picchio M, et al. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT[J]. Radiology, 2006, 238(1): 272-9.
    [23] Chung HH, Jo H, Kang WJ, et al. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence[J]. Gynecol Oncol, 2007, 104(3): 529-34.
    [24] Loft A, Berthelsen AK, Roed H, et al. The diagnostic value of PET/CT scanning in patients with cervical cancer: a prospective study[J]. Gynecol Oncol, 2007, 106(1): 29-34.
    [25] Yildirim Y, Sehirali S, Avci ME, et al. Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings[J]. Gynecol Oncol, 2008, 108(1): 154-9.
    [26] Lu BY, Che WY, Yao SZ. Role of 18F-FDG PET/CT in diagnosing idiopathy and detecting lymph node metastasis in pelves of cervical cancer[J]. Yi Xue Ying Xiang Xue Za Zhi, 2008, 18(9): 10 52-4.[卢宝彦, 车文颖, 姚树展, 等. PET/CT显像在宫颈癌原 发灶诊断及盆腔淋巴结分期的价值[J]. 医学影像学杂志, 2008, 18 (9): 1052-4.]
    [27] Kim SK, Choi HJ, Park SY, et al. Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients[J]. Eur J Cancer, 2009, 45 (12): 2103-9.
    [28] Kitajima K, Murakami K, Yamasaki E, et al. Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer[J].Eur Radiol, 2009, 19(6): 1529-36.
    [29] Chung HH, Park NH, Kim JW, et al. Role of integrated PET-CT in pelvic lymph node staging of cervical cancer before radical hysterectomy[J]. Gynecol Obstet Invest, 2009, 67(1): 61-6.
    [30] Chung HH, Kang KW, Cho JY, et al. Role of magnetic resonance imaging and positron emission tomography/computed tomography in preoperative lymph node detection of uterine cervical cancer[J]. Am J Obstet Gynecol, 2010, 203(2): 156.e1-5.
    [31] Sandvik RM, Jensen PT, Hendel HW, et al. Positron emission tomography-computed tomography has a clinical impact for patients with cervical cancer[J]. Dan Med Bull, 2011, 58(3): A4240.
    [32] Leblanc E, Gauthier H, Querleu D, et al. Accuracy of 18-fluoro- 2- deoxy-D-glucose positron emission tomography in the pretherapeutic detection of occult para-aortic node involvement in patients with a locally advanced cervical carcinoma[J]. Ann Surg Oncol, 2011, 18(8): 2302-9.
    [33] Signorelli M, Guerra L, Montanelli L, et al. Preoperative staging of cervical cancer: is 18-FDG-PET/CT really effective in patients with early stage disease?[J]. Gynecol Oncol, 2011, 123(2): 23 6-40.
    [34] Crivellaro C, Signorelli M, Guerra L, et al. 18F-FDG PET/CT can predict nodal metastases but not recurrence in early stage uterine cervical cancer[J]. Gynecol Oncol, 2012, 127(1): 131-5.
    [35] Chen HY, Wang DB, Li YN. Diagnostic value of PET-CT in detection of lymph node metastasis in early-stage cervical carcinoma[J]. Zhongguo Yi Ke Da Xue Xue Bao, 2013, 42(4): 35 1-4.[陈英汉, 王丹波, 李雅男, 等. PET-CT在检测早期子宫 颈癌淋巴结转移中的诊断价值[J]. 中国医科大学学报, 2013, 42 (4): 351-4.]
    [36] Coleman RL, Whitten CW, O'Boyle J, et al. Unexplained decrease in measured oxygen saturation by pulse oximetry following injection of Lymphazurin 1% (isosulfan blue) during a lymphatic mapping procedure[J]. J Surg Oncol, 1999, 70(2): 126-9.
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出版历程
  • 收稿日期:  2014-02-15
  • 修回日期:  2014-11-13
  • 刊出日期:  2015-03-24

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