Is there enough evidence supporting the clinical adoption of clear cell likelihood score (ccLS)? An updated systematic review and meta-analysis.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2024-10-09 DOI:10.1186/s13244-024-01829-y

Jingyu Zhong, Yangfan Hu, Yue Xing, Xianwei Liu, Xiang Ge, Yibin Wang, Yuping Shi, Junjie Lu, Jiarui Yang, Yang Song, Minda Lu, Jingshen Chu, Huan Zhang, Defang Ding, Weiwu Yao

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Abstract

Objective: To review the evidence for clinical adoption of clear cell likelihood score (ccLS) for identifying clear cell renal cell carcinoma (ccRCC) from small renal masses (SRMs).

Methods: We distinguished the literature on ccLS for identifying ccRCC via systematic search using PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data until 31 March, 2024. The risk of bias and concern on application was assessed using the modified quality assessment of diagnostic accuracy studies (QUADAS-2) tool. The level of evidence supporting the clinical adoption of ccLS for identifying ccRCC was determined based on meta-analyses.

Results: Eight MRI studies and three CT studies were included. The risk of bias and application were mainly related to the index test and flow and timing, due to incomplete imaging protocol, unclear rating process, and inappropriate interval between imaging and surgery. The diagnostic odds ratios (95% confidence intervals) of MRI and CT ccLS were 14.69 (9.71-22.22; 6 studies, 1429 SRM, 869 ccRCC), and 5.64 (3.34-9.54; 3 studies, 296 SRM, 147 ccRCC), respectively, for identifying ccRCC from SRM. The evidence level for clinical adoption of MRI and CT ccLS were both rated as weak. MRI ccLS version 2.0 potentially has better diagnostic performance than version 1.0 (1 study, 700 SRM, 509 ccRCC). Both T2-weighted-imaging with or without fat suppression might be suitable for MRI ccLS version 2.0 (1 study, 111 SRM, 82 ccRCC).

Conclusion: ccLS shows promising diagnostic performance for identifying ccRCC from SRM, but the evidence for its adoption in clinical routine remains weak.

Critical relevance statement: Although clear cell likelihood score (ccLS) demonstrates promising performance for detecting clear cell renal cell carcinoma, additional evidence is crucial to support its routine use as a tool for both initial diagnosis and active surveillance of small renal masses.

Key points: Clear cell likelihood score is designed for the evaluation of small renal masses. Both CT and MRI clear cell likelihood scores are accurate and efficient. More evidence is necessary for the clinical adoption of a clear cell likelihood score.

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是否有足够的证据支持临床采用透明细胞似然比评分（ccLS）？最新系统综述和荟萃分析。

目的综述临床采用透明细胞似然性评分（ccLS）从肾脏小肿块（SRMs）中鉴别透明细胞肾细胞癌（ccRCC）的证据：我们使用PubMed、Embase、Web of Science、中国国家知识基础设施和万方数据对截至2024年3月31日有关ccLS用于识别ccRCC的文献进行了系统检索。采用改良的诊断准确性研究质量评估（QUADAS-2）工具对偏倚风险和应用问题进行了评估。根据荟萃分析确定了支持临床采用ccLS识别ccRCC的证据水平：结果：共纳入 8 项 MRI 研究和 3 项 CT 研究。由于成像方案不完整、评级过程不明确、成像与手术之间的间隔时间不当等原因，偏倚风险和应用主要与指标检测、流程和时间有关。MRI 和 CT ccLS 从 SRM 识别 ccRCC 的诊断几率比（95% 置信区间）分别为 14.69（9.71-22.22；6 项研究，1429 例 SRM，869 例 ccRCC）和 5.64（3.34-9.54；3 项研究，296 例 SRM，147 例 ccRCC）。MRI 和 CT ccLS 的临床应用证据水平均被评为弱。MRI ccLS 2.0 版的诊断性能可能优于 1.0 版（1 项研究，700 例 SRM，509 例 ccRCC）。结论：ccLS在从SRM中鉴别ccRCC方面显示出良好的诊断性能，但将其应用于临床常规的证据仍然薄弱：尽管透明细胞似然性评分（ccLS）在检测透明细胞肾细胞癌方面显示出良好的性能，但要将其作为初始诊断和积极监测肾脏小肿块的常规工具，还需要更多的证据来支持：要点：透明细胞似然性评分专为评估肾脏小肿块而设计。CT 和 MRI 清晰细胞可能性评分均准确有效。临床采用透明细胞可能性评分需要更多证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.