18F-FDG PET和99Tcm-MDP骨扫描对乳腺癌骨转移诊断价值的Meta分析

摘要

Objective To perform a meta-analysis to evaluate the diagnostic accuracy of "F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and technetium-99m methylene diphosphonate (99Tcm-MDP) bone scintigraphy (BS) in osseous metastases detection in patients with breast cancer. Methods Studies were systematically searched in the PubMed (1966 - 2011.5),EMBASE (1974-2011. 5), the Cochrane library (1993-2011.5), CBM (1978 - 2011. 5), CNKI (1994 - 2011. 5), VIP (1989 - 2011. 5) and WanFang databases (1982 - 2011. 5). Additional studies were manually searched using the references of the retrieved articles. Studies were eligible for inclusion based on inclusion and exclusion criteria, and the qualities of the studies were reviewed based on QUADAS criteria. Patient-based and lesion-based pooled sensitivity and specificity and area under summary receiver operating characteristic (ROC) curves were calculated respectively by using Meta-disc 1. 4 and RevMan 5. 0 software. Results A total of 6 studies (222 patients/1349 lesions) were included. Meta analysis showed that compared with surgical and pathological findings: (1) The pooled patient-based sensitivity, specificity and the area under the curve (AUC) for 18F-FDG-PET were 84. 6% (95% CI: 75. 5% - 91. 3%), 93. 9% (95% CI: 88. 3% - 97. 3%) and 0. 9651, respectively. The pooled sensitivity, specificity and the AUC of bone scan were 80. 2% (95% CI: 70. 6% - 87. 8%), 85.5% (95% CI: 78. 3% -91.0%) and 0.887 8, respectively. (2) The pooled lesion-based sensitivity, specificity and the AUC for 1%F-FDG-PET were 53. 7% (95% CI: 48.8% -58.5%), 99.2% (95% CI: 98.5% -99.7%) and 0. 957 1, respectively. The pooled sensitivity, specificity and the AUC for bone scan were 87. 9% (95% CI: 84.4% -90.8%), 96. 0% (95% CI: 94. 5% - 97. 2%) and 0. 9449, respectively. Conclusions Current evidence suggests that 99Tcm-MDP bone scan is the preferred method in screening breast cancer patients with bone metastases. PET imaging can be used when physicians failed to confirm the diagnosis or met atypical lesions confirmed by MDP bone imaging and clinical suspicion of bone metastases.%目的 应用Meta分析方法评价氟脱氧葡萄糖正电子发射断层扫描(18F-fluorode oxyglucose positron emission tomography,18F-FDG PET)和亚甲基二膦酸盐(technetium-99m methylene diphosphonate,99Tcm-MDP)骨扫描诊断乳腺癌骨转移的诊断价值.方法 检索PubMed( 1966-2011.5)、EMBASE(1974-2011.5)、Cochrane图书馆(1993-2011.5)及中国生物医学文献数据库(CBM,1978-2011.5)、中国期刊全文数据库(CNKI,1994-2011.5)、中文科技期刊数据库(VIP,1989-2011.5)、万方数字化期刊群(1982-2011.5)等数据库,并追溯纳入文献的参考文献,依据纳入排除标准筛选文献,按照QUADAS评价纳入研究的质量并提取数据,利用Meta-disc 1.4和RevMan 5.0进行统计分析,计算合并敏感度、特异度、诊断比值比及其95％可信区间(95％CI)和SROC曲线下面积(AUC).结果 共纳入6个研究(222例患者/1349个病灶),Meta分析结果显示:与手术、病理相比,(1)基于患者,18F-FDG PET的合并敏感度、特异度及其95％CI、AUC分别为84.6％(75.5％～91.3％),93.9％(88.3％～97.3％),0.9651；骨扫描的合并敏感度、特异度及其95％CI、AUC分别为80.2％(70.6％～87.8％),85.5％(78.3％～91.0％),0.887 8；(2)基于病灶,18F-FDG PET的合并敏感度、特异度及其95％CI、AUC分别为53.7％(48.8％～58.5％),99.2％(98.5％～99.7％),0.957 1;骨扫描的合并敏感度、特异度及其95％CI、AUC分别为87.9％(84.4％～90.8％),96.0％(94.5％～97.2％),0.944 9.结论 当前证据提示,18Tcm-MDP骨扫描可以作为乳腺癌患者骨转移筛查的首选方法,而当MDP显像呈不典型骨病变且临床怀疑骨转移时,可考虑行PET显像确诊.