超声造影对局灶性睾丸病变诊断价值的meta分析

doi:10.3969/j.issn.1004-583X.2024.05.001

摘要/Abstract

摘要：

目的系统评价超声造影(contrast-enhanced ultrasound, CEUS)对局灶性睾丸病变的诊断价值。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方、维普(VIP)数据库,收集从建库至2023年8月10日发表的关于CEUS诊断局灶性睾丸病变的相关文献,根据纳入和排除标准筛选文献、提取数据,并行文献质量评价,采用RevMan5.4、Meta disc1.4及Stata15.0软件分析CEUS在睾丸肿瘤与肿瘤样病变、肿瘤良恶性两个方面的诊断效能。结果最终纳入13篇文献共712个病灶。Meta分析结果显示,CEUS诊断睾丸肿瘤与肿瘤样病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.87~0.98)、0.84(95%CI:0.73~0.91)、5.8(95%CI:3.3~10.2)、0.06(95%CI:0.02~0.17),合并受试者工作特征曲线下面积为0.94(95%CI:0.92~0.96);CEUS诊断睾丸良恶性病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.85~0.99)、0.81(95%CI:0.65~0.90)、4.9(95%CI:2.5~9.6)、0.06(95%CI:0.02~0.20),合并受试者工作特征曲线下面积为0.96(95%CI:0.94~0.97)。结论 CEUS对局灶性睾丸病变具有较高的诊断价值,能为临床诊疗提供参考。

关键词: 超声造影, 局灶性睾丸病变, 睾丸肿瘤与肿瘤样病变, 肿瘤良恶性病变, Meta分析

Abstract:

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in focal testicular lesions. Methods Relevant studies regarding CEUS in differentiating focal testicular lesions which reported from the establishment of the databases to August 10, 2023 were retrieved from databases including PubMed, EMBASE, Cochrane Library, Web of Science, China BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data. Eligible documents were conducted for data extraction, quality evaluation. RevMan 5.4, Meta disc1.4 and Stata15.0 were employed to analyze the diagnostic performance of CEUS for differentiating testicular lesions in tumor-like lesions and differentiation of benign and malignant. Results Thirteen original studies representing 712 lesions were included. Meta analysis showed that the pooled sensitivity, specificity, positive likelihood radio and negative likelihood ratio of CEUS for differentiating testicular neoplastic tumors in tumor-like lesions were 0.95(95%CI: 0.87-0.98), 0.84(95%CI: 0.73-0.91), 5.8(95%CI: 3.3-10.2), 0.06(95%CI: 0.02-0.17), respectively, and the area under the curve (AUC) for the summary receiver operating characteristic (SROC) was 0.94 (95%CI: 0.92-0.96). The pooled sensitivity, specificity, positive likelihood radio and negative likelihood ratio of CEUS for differentiating testicular lesions in differentiation of benign and malignant were 0.95(95%CI: 0.85-0.99), 0.81(95%CI: 0.65-0.90), 4.9 (95%CI: 2.5-9.6), 0.06(95%CI: 0.02-0.20), respectively, and the AUC for SROC was 0.96(95%CI: 0.94-0.97). Conclusion CEUS has a high diagnostic value for focal testicular lesions and can provide a reference for clinical diagnosis and treatment.

Key words: contrast-enhanced ultrasound, focal testicular lesions, neoplastic tumors and tumor-like lesions, benign and malignant neoplasms, Meta analysis

中图分类号:

R616.9

高铭, 刘昊, 于航, 林霖, 张紫杰, 熊颖. 超声造影对局灶性睾丸病变诊断价值的meta分析[J]. 临床荟萃, 2024, 39(5): 389-395.

Gao Ming, Liu Hao, Yu Hang, Lin Lin, Zhang Zijie, Xiong Ying. Diagnostic value of contrast-enhanced ultrasound in differentiating focal testicular lesions: A meta-analysis[J]. Clinical Focus, 2024, 39(5): 389-395.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.05.001

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I5/389

图/表 10

图1 文献筛选流程图

Fig.1 Flow chart of literature screening

表1 纳入文献的基本特征

Tab.1 Basic characteristics of the included studies

第一作者	发表年份	国家	研究类型	诊断标准	样本量	平均年龄 (岁)	病灶大小范围(cm)	TP (个)	FP (个)	FN (个)	TN (个)	纳入总病灶数(个)
Lock^[8]	2011	德国	前瞻性	病理	51	40.4±15.0	未报道	38	1	5	7	51
Isidori^[9]	2014	意大利	前瞻性	病理和临床	115	34.0	0.5-1.1	71^#/35^*	7^#/8^*	15^#/9^*	22^#/63^*	115
Schroder^[10]	2016	德国	前瞻性	病理	67	39.8	未报道	50	2	4	11	67
Lung^[11]	2020	英国	回顾性	病理和临床	86	39.0	0.2-6.0	44	13	2	32	91
江鑫辉^[12]	2021	中国	回顾性	病理	40	43.8±20.6	2.1-6.6	26	1	0	13	40
Yu^[13]	2022	中国	回顾性	病理	47	42.4±19.9	0.4-7.9	31	1	0	15	47
Xue^[14]	2022	中国	回顾性	病理	35	43.1±14.8	1.0-6.5	28^#/23^*	0^#/0^*	0^#/0^*	8^#/13^*	36
Liu^[15]	2023	中国	回顾性	病理和临床	79	45.9±16.1	0.9-4.4	34^#/19^*	6^#/14^*	4^#/1^*	23^#/33^*	67
Auer^[16]	2017	澳大利亚	回顾性	病理和临床	55	39.5±14.9	0.2-2.5	12	10	0	33	55
Lerchbaumer^[17]	2019	德国	回顾性	病理和临床	45	42.0	1.4-4.6	13	2	1	29	45
Schwarze^[18]	2020	德国	回顾性	病理	49	46.0	0.2-8.0	33	9	3	4	49
Liu^[19]	2021	中国	回顾性	病理和临床	9	38.0	0.8-5.2	5	1	0	3	9
李振东^[20]	2023	中国	回顾性	病理	40	36.5±15.9	0.4-8.0	16	6	0	18	40

图2 纳入研究风险偏倚图

Fig.2 Risk of bias graph for the included studies

图3 纳入研究风险偏倚总体分布

Fig.3 Risk of bias in overall distribution chart for the included studies

图4 CEUS诊断睾丸肿瘤与肿瘤样病变的合并敏感度和特异度

Fig.4 The pooled sensitivity and specificity in CEUS for differentiating testicular neoplastic tumors in tumor-like lesions

图5 CEUS诊断睾丸肿瘤与肿瘤样病变的SROC曲线

Fig.5 The SROC curve in CEUS for differentiating testicular neoplastic tumors in tumor-like lesions

图6 CEUS诊断睾丸良恶性病变的合并敏感度和特异度

Fig.6 The pooled sensitivity and specificity in CEUS for differentiating testicular benign from malignant neoplasms

图7 CEUS诊断睾丸良恶性病变的SROC曲线

Fig.7 The SROC curve in CEUS for differentiating testicular benign from malignant neoplasms

图8 CEUS诊断睾丸局灶性病变纳入文献的敏感性分析 a.睾丸肿瘤与肿瘤样病变;b.睾丸良恶性病变

Fig.8 Sensitivity analysis of included studies for CEUS in differentiating focal testicular lesions a. Testicular neoplastic tumors and tumor-like lesions; b. Testicular benign and malignant neoplasms

图9 CEUS诊断局灶性睾丸病变的漏斗图 a.睾丸肿瘤与肿瘤样病变; b.睾丸良恶性病变

Fig.9 Funnel plots of CEUS in differentiating focal testicular lesions a.Testicular neoplastic tumors and tumor-like lesions; b. Testicular benign and malignant neoplasms

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