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目的:应用循证医学及Meta分析方法评估18F-脱氧葡萄糖(fluorodeoxyglucose,FDG)和18 F-脱氧胸腺嘧啶核苷(fluorothymidine,FLT)正电子发射断层扫描(positron emission tomography,PET)在肺恶性结节诊断中的价值。方法:检索PubMed、Ovid、Cochrane图书馆、CNKI、万方数据库和中文科技期刊数据库等,依据纳入及排除标准筛选文献,按照诊断精确性研究的质量鉴定(quality assessment of studies of diagnostic accuracy included in systematic reviews,QUADAS)标准行质量评价,提取数据并用Meta-disc 1.4软件行Meta分析,计算合并敏感度、合并特异度、汇总受试者工作曲线(summary receiver-operating characteristic curves,SROC)及曲线下面积(areas under the curve,AUC)等。结果:最终纳入7篇文献。FDG PET敏感度为0.844,95%CI:0.791~0.888,特异度仅为0.477,95%CI:0.405~0.549;FLT PET敏感度为0.784,95%CI:0.725~0.835,特异度为0.677,95%CI:0.606~0.742;FDG和FLT的SROC AUC分别为0.757 0和0.820 1,P=0.273。结论:FDG PET对肺部恶性病变敏感性很高但特异度差,FLT PET敏感性和特异度较均衡;在肺部恶性肿瘤的诊断中,FLT尚不能代替FDG的应用;FDG PET的优势在于探寻隐匿的肿瘤病灶和肿瘤分期等方面;FLT PET的优势在于减少炎性反应所致的假阳性结果。
OBJECTIVE: To evaluate the clinical value of 18F-fluorodeoxyglucose (FDG) and 18 F-thymidine (FLT) positron emission tomography (PET) The value of diagnosis. Methods: The PubMed, Ovid, Cochrane Library, CNKI, Wanfang Database and Chinese Sci-tech Periodical Database were searched and screened according to inclusion and exclusion criteria. According to the quality assessment of studies of diagnostic accuracy included in systematic reviews, QUADAS) standard quality data were extracted and the data were extracted and Meta-analysis was performed using the Meta-disc 1.4 software to calculate the combined sensitivity, combined specificity, summary receiver-operating characteristic curves (SROC) and area under the curve (areas under the curve, AUC) and the like. Results: The final inclusion of 7 articles. FDG PET sensitivity was 0.844, 95% CI: 0.791 ~ 0.888, specificity was only 0.477, 95% CI: 0.405 ~ 0.549; FLT PET sensitivity was 0.784, 95% CI: 0.725 ~ 0.835, specificity was 0.677, 95 % CI: 0.606 ~ 0.742; SROC AUC of FDG and FLT were 0.757 0 and 0.820 1 respectively, P = 0.273. Conclusions: FDG PET is highly sensitive to lung malignancies, but its specificity is poor. FLT PET is more sensitive and specific. In the diagnosis of pulmonary malignancies, FLT can not substitute for FDG. The advantage of FDG PET is that Explore hidden tumor lesions and tumor staging and so on; FLT PET has the advantage of reducing the false-positive results of inflammatory reaction.