华西口腔医学杂志

• 临床研究 • 上一篇    下一篇

增强CT在诊断口腔癌下颌骨侵犯中的价值:基于诊断性试验的系统评价

李春洁 孙海滨 门乙 杨文宾 李一 李龙江   

  1. 口腔疾病研究国家重点实验室 华西口腔医院头颈肿瘤外科(四川大学),成都 610041
  • 出版日期:2015-02-01 发布日期:2015-02-01
  • 通讯作者: 李龙江,教授,博士,E-mail: muzili63@163.com
  • 作者简介:李春洁,主治医师,博士,E-mail:lichunjie009@sina.com
  • 基金资助:

    2014年四川大学青年教师科研启动基金资助项目(2014SCU11032)

Contrast-enhanced CT for the diagnosis of mandibular invasion caused by oral cancers: a systematic review

 Li Chunjie, Sun Haibin, Men Yi, Yang Wenbin, Li Yi, Li Longjiang   

  1. State Key Laboratory of Oral Diseases, Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Online:2015-02-01 Published:2015-02-01

摘要:

目的  评价增强CT诊断口腔癌下颌骨侵犯的诊断效能。方法 对PubMed、荷兰医学文摘EMBASE、欧洲灰色文献数据库、中国生物医学文献数据库及重庆维普数据库进行电子检索,检索时间截至2014年1月3日;同时手工检索19种中文口腔医学杂志。两位评价者独立使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用Meta Disc 1.4软件进行Meta分析。结果  共纳入14篇研究,共涉及患者642名,其中7篇研究为前瞻性研究,1篇研究存在低偏倚风险,其余研究的偏倚风险情况不清。Meta分析结果显示:增强CT诊断下颌骨侵犯的合并敏感度(SEN)为0.718 ,95%可信区间(CI)为0.665~0.767,合并特异度(SPE)为0.909,95%CI为0.872~0.938,曲线下面积(AUC)为0.906 1,Q*值为0.837 8;增强CT在诊断口腔癌下颌骨骨髓侵犯时,SEN为0.787(0.643~0.893),SPE为0.904(0.790~0.968),AUC为0.949 6,Q*值为0.890 0。Meta回顾显示层厚较低的增强CT诊断效能较高。结论  增强CT在诊断口腔癌下颌骨侵犯及下颌骨骨髓侵犯时有较高的诊断效能,其SPE较高,适合用于颌骨侵犯的确诊。选择层厚较低的增强CT能够提高诊断效能。

关键词:  , 增强CT, 口腔癌, 下颌骨, 诊断, Meta分析, 系统评价

Abstract:

Objective To assess the diagnostic efficacy of contrast-enhanced CT in diagnosing mandibular invasion of oral cancers. Methods  PubMed, Excerpta Medica Database (EMBASE), the European Grey Literature Database, Chinese Biomedical Literature Database (CBM), and CQVIP were searched electronically on January 03, 2014. Hand-searching was also performed on 19 relevant Chinese journals. The methodological quality assessment, as suggested in Cochrane Handbook, and the data extraction of the studies included were performed by two reviewers in duplicate. Meta-analysis was conducted using the Meta Disc 1.4 software. Results  Fourteen studies that involved 642 participants were included. Among the seven prospective studies, one had a low bias risk and the rest had unclear bias risks. When mandibular invasion was diagnosed the Meta-analysis results showed that the pooled sensitivity (SEN) was 0.718 [95% confidence interval (CI), 0.665-0.767], the pooled specificity (SPE) was 0.909 (95% CI, 0.872–0.938), the area under curve (AUC) was 0.906 1, and the Q* was 0.837 8. When mandibular medullary invasion was diagnosed, the SEN was 0.787 (0.643–0.893), the SPE was 0.904 (0.790–0.968), the AUC was 0.949 6, and the Q* was 0.890 0. The Meta-regression results showed that the smaller slide thickness had a higher diagnosis efficacy. Conclusion CT showed a high efficacy in diagnosing mandibular or medullary invasion caused by oral cancers. With a high SPE, contrast-enhanced CT can confirm the clinical diagnosis of bone invasion effectively. In addition, selecting a smaller slide thickness CT can increase diagnosis efficacy.

Key words: contrast-enhanced CT, oral cancer, mandible, diagnosis, Meta-analysis, systematic review