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目的探讨Technetium99mMIBI(99mTcMIBI)乳腺核素显像诊断原发乳癌及腋窝淋巴结转移的价值。方法检索Cochrane图书馆、MEDLINE、Springer、Elsevier及中国期刊网中有关99mTcMIBI乳腺核素显像标准与病理诊断(金标准)比较诊断原发乳癌及腋窝淋巴结转移的前瞻性临床试验,提取并评价各纳入研究的特征性信息及检测敏感度、特异度等指标。根据不同的效应量选择不同的效应模型,并进行加权定量合并,计算汇总敏感度、特异度及其相应的95%CI,绘制汇总受试者工作特征曲线(SROC),计算曲线下面积(AUC)来评价其诊断价值。结果99mTcMIBI乳腺核素显像诊断乳腺癌的汇总敏感度和特异度及其相应的95%CI分别为86%[95%CI(82%,89%)]和80%[95%CI(75%,80%)],AUC为90.29%。对于可触之的乳腺包块99mTcMIBI乳腺核素显像诊断乳腺癌的汇总敏感度和特异度及其相应95%CI分别为86%[95%CI(83%,88%)]和83%[95%CI(77%,86%)],AUC为94.68%。对不可触之乳腺肿块,相应汇总值分别为69%[95%(47%,85%)]和69%[95%CI(52%,82%)],AUC为78.97%。对腋窝淋巴结转移诊断的汇总敏感度和特异度及其相应95%CI分别为75%[95%CI(66%,81%)]和84%[95%CI(75%,91%)],AUC为87.64%。结论对于可触之的乳腺肿块99mTcMIBI乳腺核素显像诊断原发性乳腺癌的价值较高对腋窝淋巴结转移的特异性也较好,但敏感度尚需提高。然而对于不可触之的乳腺肿块,其诊断价值则有限。
Objective To investigate the value of Technetium99mMIBI (99mTcMIBI) breast radionuclide imaging in the diagnosis of primary breast cancer and axillary lymph node metastasis. Methods A prospective clinical trial comparing 99mTcMIBI breast imaging with pathological diagnosis (gold standard) in the diagnosis of primary breast cancer and axillary lymph node metastasis was retrieved from the Cochrane Library, MEDLINE, Springer, Elsevier and China Journal Net. Included in the study of characteristic information and detection sensitivity, specificity and other indicators. Different effect models were selected according to the different effects, and weighted quantitative analysis was performed to calculate the summary sensitivity, specificity and their corresponding 95% CI. The summary receiver operating characteristic curve (SROC) was drawn and the area under the curve ) To evaluate its diagnostic value. Results The pooled sensitivity and specificity of 99mTcMIBI breast imaging and their corresponding 95% CIs were 86% [95% CI (82%, 89%)] and 80% [95% CIs (75% , 80%)], AUC 90.29%. The pooled sensitivity and specificity of the diagnostic 99mTcMIBI breast radionuclide imaging for palpable breast mass with a corresponding 95% CI of 86% [95% CI (83%, 88%)] and 83% [ 95% CI (77%, 86%)] with an AUC of 94.68%. For non-palpable breast masses, the corresponding aggregated values were 69% [95% (47%, 85%)] and 69% [95% CI (52%, 82%)], respectively. The AUC was 78.97%. The pooled sensitivity and specificity for the diagnosis of axillary lymph node metastases and their corresponding 95% CIs were 75% [95% CI (66%, 81%)] and 84% [95% CIs (75%, 91% AUC was 87.64%. Conclusions The specificity of 99mTcMIBI breast radionuclide imaging in the diagnosis of primary breast cancer for axillary lymph node metastasis is good, but its sensitivity needs to be improved. However, for non-palpable breast lumps, its diagnostic value is limited.