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目的:探讨超声内镜(endoscopic ultrasonography,EUS)、多排螺旋CT(multidetector spiral computed tomography,MSCT)、磁共振(magnetic resonance imaging,MRI)、正电子发射断层扫描(positron emission tomography,PET)对胃癌术前淋巴结转移(N分期)的诊断价值。方法 :从Pub Med、EMBASE、Elsevier、Wiley Inter Science、Springer、The Cochrane Library、Clinical Trials.gov数据库系统检索获取1997年至2012年的相关文献,依据纳入、排除标准筛选文献,提取资料并进行文献质量评价后,采用Review Manager 5.0和Meta-Disc 1.4软件进行荟萃分析。结果:共纳入41项研究,合计5 767例病人。荟萃分析结果显示:1PET对N0诊断灵敏度最高,EUS、MSCT、MRI的灵敏度比较无统计学差异。MSCT与MRI对N0诊断特异度较高,两者间无统计学差异,EUS次之,PET最低。2EUS与MSCT对N1诊断灵敏度较高,两者间无统计学差异,MRI与PET较低,后两者间无统计学差异。PET对N1诊断特异度最高,MSCT次之,EUS、MRI最低,后两者间无统计学差异。3MSCT对N2/3诊断灵敏度最高,余三者间无统计学差异。PET与EUS对N2/3诊断特异度最高,两者间无统计学差异,MSCT次之,MRI最低。4术前淋巴结转移诊断能力(总体N分期)方面,MRI与MSCT灵敏度较高,两者间无统计学差异,EUS次之,PET最低。PET特异度最高,MSCT与EUS次之,后两者间无统计学差异,MRI最低。54种方法对N0、N1、N2/3及N分期总体诊断的AUC值间无统计学差异,均位于0.70~0.90。结论:4种方法对N0、N1、N2/3及N分期总体的诊断灵敏度、特异度虽有差异,但综合诊断效能间无统计学差异,均拥有中等诊断价值。
Objective: To investigate the effect of endoscopic ultrasonography (EUS), multidetector spiral computed tomography (MSCT), magnetic resonance imaging (MRI) and positron emission tomography (PET) Preoperative lymph node metastasis (N staging) diagnostic value. METHODS: The relevant literature from 1997 to 2012 was retrieved from the Pub Med, EMBASE, Elsevier, Wiley Inter Science, Springer, The Cochrane Library, Clinical Trials.gov database system. According to the inclusion and exclusion criteria, the literature was screened, the data were extracted and the literature After quality assessment, meta-analyzes were performed using Review Manager 5.0 and Meta-Disc 1.4 software. Results: A total of 41 studies were included, totaling 5,767 patients. The results of meta-analysis showed that 1PET had the highest sensitivity for N0 diagnosis and no significant difference in EUS, MSCT and MRI. MSCT and MRI diagnosis of N0 higher specificity, no significant difference between the two, EUS second, PET the lowest. The sensitivity of 2EUS and MSCT in diagnosing N1 was high, with no significant difference between the two. MRI and PET were lower, but there was no significant difference between the two. PET diagnosis of N1 highest specificity, followed by MSCT, EUS, MRI lowest, the latter two no significant difference. The sensitivity of 3MSCT to N2 / 3 was the highest, while there was no significant difference among the other three. PET and EUS had the highest specificity for the diagnosis of N2 / 3, with no significant difference between them, with MSCT followed by MRI with the lowest. The diagnostic accuracy of preoperative lymph node metastasis (overall N stage), MRI and MSCT higher sensitivity, no significant difference between the two, EUS second, PET lowest. The highest specificity of PET, MSCT and EUS followed by no statistical difference between the two, MRI lowest. There was no significant difference between the 54 methods in the overall diagnosis of N0, N1, N2 / 3 and N stage AUC values, all at 0.70 ~ 0.90. Conclusion: Although the diagnostic sensitivity and specificity of the four methods for the overall N0, N1, N2 / 3 and N staging are different, there is no statistical difference between the comprehensive diagnostic efficacy, all of them have the medium diagnostic value.