放射导向定位对乳腺触诊阴性病变的诊断价值研究：Meta分析

doi:10.3969/j.issn.2095-9400.2019.02.009

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摘要目的：评估放射导向隐匿性病灶定位技术（ROLL）对触诊阴性乳腺病变（NPBLs）的诊断价值。方法：检索数据库包括PubMed、EMBASE、Cochrane图书馆、万方数据库、中国知网及维普数据库，检索时间均从建库至2017年4月。此外，对相关文章的参考文献也进行人工检索。采用OR（95%CI）评价ROLL组与导丝定位法（WGL）组二分类数据的差异，采用均数差（MD）及95%CI评价ROLL组与WGL组连续性数据的差异。根据纳入研究类型进行亚组分析；对纳入的每篇文献依次剔除进行敏感性分析；采用Egger法检验是否存在发表偏倚。结果：共纳入文献18篇（9篇RCT，9篇非RCT），共纳入2 370例患者，其中ROLL组1 297例，WGL组1 073例。结果显示ROLL组切缘阳性率（OR=0.54，95%CI=0.42～0.70）、术中再切除率（OR=0.56，95%CI=0.40～0.79）及再次手术率（OR=0.66，95%CI=0.48～0.90）均明显低于WGL组；而2组间定位并发症率（OR=0.61，95%CI=0.24～1.52）、病灶成功切除率（OR=1.13，95%CI=0.54～2.38）、术后并发症率（OR=0.82，95%CI=0.50～1.34）、切除标本体积（MD=-0.76，95%CI=-6.00～4.47）及手术时间（MD=-0.05，95%CI=-1.07～0.98）差异均无统计学意义。结论：基于本系统评价及Meta分析的研究结果，ROLL可能是一种能够代替WGL的NPBLs诊断方法。

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关键词 ：触诊阴性乳腺病变, 放射导向隐匿性病灶定位技术, 导丝定位技术, Meta分析

Abstract：Objective: To evaluate the diagnostic value of radio-guided occult lesion localization (ROLL) for non-palpable breast lesions against wire-guided localization (WGL). Methods: The databases included PubMed, EMBASE, Cochrane Library database, CNKI, WANFANG database. The retrieval time was from the construction of the database to April 2017. In addition, reference documents of related articles were also searched manually. OR(95%CI) were used to evaluate the difference between ROLL group and WGL group, and mean difference (MD) and 95%CI were used to evaluate the difference between ROLL group and WGL group. A subgroup analysis was made according to the type of study design (randomized or nonrandomized study). Sensitivity analysis was performed by the sequential omission of each individual study, and to explore the cause of heterogeneity in the studies. The Egger method was used to test whether there was publication bias. Results: 18 studies (9 RCTs, 9 non-randomized studies) were eligible with ROLL versus WGL compared. Of the trials we included in the meta-analysis, there were a total of 2 370 participants with non-palpable breast lesions [1 297 participants (ROLL); 1 073 participants (WGL)]. The results showed ROLL favorable results in positive excision margins (OR=0.54, 95%CI=0.42-0.70, 1 864 participants, 16 trials), intra-operative re-excision (OR=0.56, 95%CI=0.40-0.79, 1 132 participants, 10 trials) and re-operation rates (OR=0.66, 95%CI=0.48-0.90, 1 569 participants, 11 trials) versus WGL. There were no significant differences in localization complication (OR=0.61, 95%CI=0.24-1.52, 1 375 participants, 11 trials), successful excision (OR=1.13, 95%CI=0.54-2.38, 2 370 participants, 18 trials), postoperative complications (OR=0.82, 95%CI=0.50-1.34, 1 467 participants, 9 trials), specimen volume (MD=-0.76, 95%CI=-6.00-4.47, 686 participants, 4 trials) and operation time (MD=-0.05, 95%CI= -1.07-0.98, 849 participants, 6 trials). Conclusion: Based on this review of the published trials, ROLL may be a method of NPBLs diagnosis in place of WGL.

Key words： non-palpable breast lesions radioguided occult lesion localization wire-guided locali-zation Meta-analysis

基金资助:浙江省医药卫生科技计划项目（218KY883）。

通讯作者: 季文斌，主任医师，Email：jiwenbin2016@163.com。

作者简介: 吴娟（1988-），女，江苏徐州人，主治医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2019.02.009 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I2/117

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