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首頁> 外文期刊>Canadian Medical Association Journal: Journal de l'Association Medicale Canadienne >Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis.
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Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis.

機譯：原發(fā)性宮頸癌淋巴結(jié)狀態(tài)測試的診斷準確性：系統(tǒng)評價和薈萃分析。

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BACKGROUND: Lymph node status is the key to determining the prognosis and treatment of cervical cancer. However, it cannot be assessed clinically, and testing for nodal metastasis is controversial. We sought to systematically review the diagnostic accuracy literature on sentinel node biopsy, positron emission tomography, magnetic resonance imaging and computed tomography to evaluate the accuracy of each index test in determining lymph node status in patients with cervical cancer. METHODS: We searched MEDLINE (1966-2006), EMBASE (1980-2006), Medion (1980-2006) and the Cochrane library (Issue 2, 2006) for relevant articles. We also manually searched the reference lists from primary articles and reviews, and we contacted experts in the field for conference abstracts and unpublished studies. We performed random-effects meta-analysis of accuracy indices, and we performed meta-regression analysis to test the effect of study quality on diagnostic accuracy and to identify other sources of heterogeneity. RESULTS: We included 72 relevant primary studies, involving a total of 5042 women, in our analysis. We found that, in determining lymph node status, sentinel node biopsy had a pooled positive likelihood ratio of 40.8 (95% confidence interval [CI] 24.6-67.6) and a pooled negative likelihood ratio of 0.18 (95% CI 0.14-0.24). The pooled positive likelihood ratios (and 95% CI) were 15.3 (7.9-29.6) for positron emission tomography, 6.4 (4.9-8.3) for magnetic resonance imaging and 4.3 (3.0-6.2) for computed tomography. The pooled negative likelihood ratios (and 95% CIs) were 0.27 (0.11-0.66) for positron emission tomography, 0.50 (0.39-0.64) for magnetic resonance imaging and 0.58 (0.48-0.70) for computed tomography. Using a 27% pretest probability of lymph node metastasis among all cases (regardless of stage), we found that a positive sentinel node biopsy result increased post-test probability to 94% (95% CI 90%-96%), whereas a positive finding on positron emission tomography increased it to 85% (75%-92%). INTERPRETATION: Sentinel node biopsy has greater accuracy in determining lymph node status among women with primary cervical cancer than current commonly used imaging methods.
機譯：背景：淋巴結(jié)狀態(tài)是決定宮頸癌預(yù)后和治療的關(guān)鍵。然而，它不能在臨床上進行評估，并且淋巴結(jié)轉(zhuǎn)移的測試存在爭議。我們試圖系統(tǒng)地回顧有關(guān)前哨淋巴結(jié)活檢，正電子發(fā)射斷層掃描，磁共振成像和計算機斷層掃描的診斷準確性文獻，以評估確定宮頸癌患者淋巴結(jié)狀態(tài)的各項指標測試的準確性。方法：我們在MEDLINE（1966-2006），EMBASE（1980-2006），Medion（1980-2006）和Cochrane庫（2006年第2期）中進行搜索，以查找相關(guān)文章。我們還從主要文章和評論中手動搜索了參考列表，并與該領(lǐng)域的專家聯(lián)系以獲取會議摘要和未發(fā)表的研究。我們進行了準確性指標的隨機效應(yīng)薈萃分析，并進行了薈萃回歸分析，以檢驗研究質(zhì)量對診斷準確性的影響并確定其他異質(zhì)性來源。結(jié)果：我們納入了72項相關(guān)的基礎(chǔ)研究，涉及5042名女性。我們發(fā)現(xiàn)，在確定淋巴結(jié)狀態(tài)時，前哨淋巴結(jié)活檢的合并陽性似然比為40.8（95％置信區(qū)間[CI] 24.6-67.6），合并陰性陰性似然比為0.18（95％CI 0.14-0.24）。正電子發(fā)射斷層顯像的合并正似然比（和95％CI）分別為15.3（7.9-29.6），磁共振成像為6.4（4.9-8.3）和計算機斷層顯像為4.3（3.0-6.2）。對于正電子發(fā)射斷層掃描，合并的負似然比（和95％CI）為0.27（0.11-0.66），對于磁共振成像為0.50（0.39-0.64），對于計算機斷層攝影為0.58（0.48-0.70）。使用所有病例中淋巴結(jié)轉(zhuǎn)移的測試前概率為27％（不分階段），我們發(fā)現(xiàn)陽性前哨淋巴結(jié)活檢結(jié)果將測試后概率提高到94％（95％CI 90％-96％），而陽性在正電子發(fā)射斷層顯像中發(fā)現(xiàn)的比例增加到85％（75％-92％）。解釋：與目前常用的影像學(xué)檢查方法相比，前哨淋巴結(jié)活檢在確定原發(fā)性宮頸癌女性淋巴結(jié)狀態(tài)方面具有更高的準確性。

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