乳腺X线摄影技术应用于人群筛查准确性的Meta分析

朱陈; 王乐; 杜灵彬; 李静; 张娟; 代敏; 石菊芳

文章摘要

朱陈,王乐,杜灵彬,李静,张娟,代敏,石菊芳.乳腺X线摄影技术应用于人群筛查准确性的Meta分析[J].中华流行病学杂志,2016,37(9):1296-1305

乳腺X线摄影技术应用于人群筛查准确性的Meta分析

The accuracy of mammography screening for breast cancer: a Meta-analysis

收稿日期:2016-05-04 出版日期:2016-09-14

DOI：10.3760/cma.j.issn.0254-6450.2016.09.022

中文关键词: 乳腺癌乳腺X线摄影筛查灵敏度特异度

英文关键词: Breast cancer Mammography Screening Sensitivity Specificity

基金项目:国家重大公共卫生服务项目（城市癌症早诊早治项目）；国家自然科学基金（81402740）；教育部高等学校博士学科点专项科研基金（20131106120014）

作者	单位	E-mail
朱陈	310022 杭州, 浙江省肿瘤医院, 浙江省癌症中心, 浙江省肿瘤防治办公室
王乐	100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院, 城市癌症早诊早治项目办公室
杜灵彬	310022 杭州, 浙江省肿瘤医院, 浙江省癌症中心, 浙江省肿瘤防治办公室	yjsdlb0407@126.com
李静	100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院, 城市癌症早诊早治项目办公室 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院, 影像诊断科
张娟	310022 杭州, 浙江省肿瘤医院, 放射科
代敏	100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院, 城市癌症早诊早治项目办公室
石菊芳	100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院, 城市癌症早诊早治项目办公室	shijf@cicams.ac.cn

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中文摘要:

目的对全球X线摄影技术运用于乳腺癌筛查的准确性研究进行Meta分析。方法在Medline、Embase、Cochrane和中国学术期刊网全文数据库（CNKI）文献库中，通过疾病名称、筛查干预、结果指标等关键词整合进行检索。截至2015年6月4日，共检索获得1 167篇文献。根据纳入和排除标准筛选，主要摘录筛查试验中的真阳性、假阳性、假阴性、真阴性的“四格表”数据。采用QUADAS量表进行文献质量评价。利用综合受试者工作特征（SROC）分析方法判断研究间的阈值效应并计算曲线下面积（AUC），采用双变量混合效应模型对X线摄影技术在所有人群和乳腺致密的亚组人群中筛查的灵敏度及特异度进行Meta分析；对样本量大于10万的亚组进行敏感性分析。利用Q检验和I2统计量分析文献异质性，以漏斗图和线性回归方法检验发表偏倚。结果最终纳入文献48篇（欧洲地区及美国38篇、亚洲地区8篇、大洋洲地区2篇），总样本量为8 551 873例，筛查开展时间为1975-2013年，对象起止筛查年龄大部分在40～75岁。分析得出，X线摄影技术用于乳腺癌筛查的AUC为0.95（95% CI：0.93～0.97），总体灵敏度为0.81（95% CI：0.77～0.84），总体特异度为0.96（95% CI：0.94～0.96），敏感性分析提示该结果稳定。其中对乳腺致密人群的亚组分析显示，X线摄影技术的合并灵敏度和特异度分别为0.74（95% CI：0.61～0.83）和0.93（95% CI：0.89～0.96）。漏斗图和线性回归结果显示纳入研究不存在发表偏倚。结论 X线摄影作为乳腺癌筛查技术具有较高灵敏度和特异度，但对乳腺致密女性的筛查准确性降低。

英文摘要:

Objective To estimate the accuracy of mammography for population-based breast cancer screening. Methods Studies of screening mammography performance were systematically reviewed in the Medline, Embase, Cochrane and China National Knowledge Infrastructure (CNKI) literature databases. The retrieval was performed by using related key words, including disease name, screening and intervention indicators and study type. A total of 1 167 records were retrieved by June 4, 2015 and those studies met the inclusion criteria were included for the current analysis. The numbers of true-positive, false-positive, false-negative and true-negative were originally extracted and calculated from each individual study. A QUADAS checklist was used to assess the quality of the studies. A curve of summary receiver operating characteristic (SROC) was applied as a comprehensive assessment of diagnosed accuracy. The pooled effect size of both sensitivity and specificity was quantitatively synthesized in both total population and subgroup with dense breast using the bivariate mixed-effects models. We conducted a sensitivity analysis in the studies with sample size over 100 000. Heterogeneity between studies was measured by the Q test and I² statistic, and publication bias was evaluated by a funnel plot and the linear regression test. Results A total of 48 publications with 8 551 873 individuals were identified for the final qualitative synthesis, most of them were from Europe area and American (38 studies), 8 were from Asia area, and 2 were from Oceania area. The studies were conducted during period of 1975-2013, and the age of study women ranged mostly from 40 to 75 years. The area under the SROC curve (AUC) was 0.95 (95%CI:0.93-0.97). It was estimated that the pooled sensitivity and specificity were 0.81 (95%CI:0.77-0.84) and 0.96 (95%CI:0.94-0.96), respectively. The results were indicated stable and robust in sensitivity analysis. In the subgroup with dense breast, the sensitivity and specificity were 0.74 (95%CI:0.61-0.83) and 0.93 (95%CI:0.89-0.96), respectively. Funnel plot and test results showed there was no significant publication bias among the included studies. Conclusion The accuracy of mammography is high for population-based breast cancer screening in women, although the sensitivity is lower in women with dense breast.

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