普通支气管镜联合自发性荧光支气管镜在肺癌早期定位诊断中的系统评价

摘要

目的 采用Meta分析方法评价普通荧光支气管镜联合自发性荧光支气管镜在肺癌早期诊断中的价值,为临床应用提供依据.方法 检索PubMed、ISI Web of Knowledge、Chest、Cochrane等数据库,检索时间为1990～2010年,收集普通荧光支气管镜联合自发性荧光支气管镜对肺癌早期诊断的相关文献；按纳入与排除标准筛选文献并对纳入文献进行质量评价；采用MetaDiscl.4软件对数据进行异质性分析,计算汇总敏感度、特异度、汇总似然比及汇总受试者工作特征曲线(SROC曲线),综合评价普通支气管镜联合自发性荧光支气管镜在肺癌早期诊断中的价值.结果 共纳入10篇文献,样本量为2157例,共获取活检标本4804例,其中经病理证实为中重度不典型增生、原位癌及侵袭癌的标本为2 183例.异质性检验提示无阈值效应,但存在其他原因导致的异质性,按随机效应模型进行Meta分析得出汇总灵敏度为0.84(95％ CI:0.81～0.86),汇总特异度为0.61(95％ CI:0.60～0.63),汇总阳性似然比为2.25(95％ CI:2.12～2.39),汇总阴性似然比为0.27(95％ CI:0.23～0.32),SROC曲线下面积为0.839 5.亚组分析结果显示,6个使用肺成像荧光屏内镜(LIFE)系统的SROC曲线下面积为0.841 5,4个使用D-light Storz系统的SROC曲线下面积为0.8841.结论 普通荧光支气管镜联合自发性荧光支气管镜在肺癌的早期诊断中具有一定的特异性,敏感性较高,有一定的诊断价值,可作为临床较重要的参考指标.%Objective To evaluate the diagnostic value of white light bronchoscopy combined with autofluorescence bronchoscopy (AFB) for early diagnosis of lung cancer by rneta-analysis. Methods We searched PubMed, ISI Web of Knowledge, Chest, Cochrane and other databases (1990 - 2010) to collect studies which evaluated the diagnostic value of AFB for early diagnosis of lung cancer. The heterogeneity of included studies was tested by Meta-Discl. 4 software. The diagnostic value of WLB combines AFB for early diagnosis of lung cancer was evaluated by the pooled sensitivity, specificity, the likelihood ratio (LR) and summary receiver operating characteristic curve (SROC curve) statistical indicators. Results Ten articles were collected and 2 157 cases were included in the studies. Totally 4 804 biopsies were obtained and 2 183 specimens were confirmed to be moderate or severe dysplasia, carcinoma in situ (CIS) and invasive cancer by pathology. Heterogeneity was found except for threshold effect. A meta-analysis was performed using the random effect model, and the value of the weighted sensitivity was 0. 84 (95% CI :0.81-0.86), the specificity was 0.61 (95% CI:0.60-0.63), the positive likelihood ratio was 2.25 (95% CI-. 2.12-2.39), negative likelihood ratio was 0.27 (95% CI:0.23-0.32), and the SROC area under the curve (AUC) was 0. 839 5. Subgroup analyses indicated that the SROC area under the curve (AUC) was 0.841 5 (by LIFE system) and (by D-light Storz system) 0.884 1. Conclusion WLB combined with AFB has a certain specificity and high sensitivity for early diagnosis of lung cancer and could be regarded as one of the reference tests.