描述 T1 肾肿瘤特征的成像模式：诊断准确性的系统回顾和荟萃分析

IF 1.6 Q3 UROLOGY & NEPHROLOGY BJUI compass Pub Date : 2024-06-21 DOI:10.1002/bco2.355

Hannah Warren, Jack B. Fanshawe, Valerie Mok, Priyanka Iyer, Vinson Wai-Shun Chan, Richard Hesketh, Eleanor Zimmermann, Veeru Kasivisvanathan, Mark Emberton, Maxine G. B. Tran, Kurinchi Gurusamy

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引用次数: 0

摘要

目标国际指南建议对疑似局部肾细胞癌（RCC）进行切除，但手术系列显示 30% 的病理为良性。区分良性和恶性肿瘤的非侵入性诊断测试是一项尚未满足的需求。我们的目标是确定成像模式检测 T1 肾肿瘤癌症的诊断准确性。方法对从开始到 2023 年 1 月有关 T1 肾肿块的任何成像检测与组织病理学参考标准相比的诊断准确性的报道进行了系统性回顾。27篇文献（包括2044名参与者的2277个肿瘤）被纳入系统综述，9篇被纳入荟萃分析。结果对 CT（7 项记录，1118 名参与者）、对比增强超声波（7 项记录，197 名参与者）、[99mTc]Tc-sestamibi SPECT/CT（5 项记录，263 名参与者）、核磁共振成像（5 项记录，263 名参与者）的敏感性和特异性绘制了森林图、[68Ga]Ga-PSMA-11 PET（1 份记录，27 名参与者）和[111In]In-girentuximab SPECT/CT（1 份记录，8 名参与者）。元分析结果显示，[99mTc]锝-铯-SPECT/CT 的灵敏度和特异度汇总估计值分别为 88.6%（95% CI 82.7%-92.6%）和 77.0%（95% CI 63.0%-86.9%），[18F]FDG PET 的灵敏度和特异度汇总估计值分别为 53.5%（95% CI 1.6%-98.8%）和 62.5%（95% CI 14.0%-94.5%）。分层汇总接收者操作特征（HSROC）比较模型没有收敛。由于检测阳性的阈值不同，未对其他成像进行 Meta 分析。结论 T1 肾肿块的最佳成像策略尚不明确。[99mTc]Tc-sestamibi SPECT/CT 是一种新兴的工具，但还需要进一步的研究来确定其在临床实践中的作用。如果能对 CT、MRI 和对比增强超声的诊断阈值进行标准化，以促进未来的荟萃分析，将会使该领域受益匪浅。

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Imaging modalities for characterising T1 renal tumours: A systematic review and meta-analysis of diagnostic accuracy

Objectives

International guidelines recommend resection of suspected localised renal cell carcinoma (RCC), with surgical series showing benign pathology in 30%. Non-invasive diagnostic tests to differentiate benign from malignant tumours are an unmet need. Our objective was to determine diagnostic accuracy of imaging modalities for detecting cancer in T1 renal tumours.

Methods

A systematic review was performed for reports of diagnostic accuracy of any imaging test compared to a reference standard of histopathology for T1 renal masses, from inception until January 2023. Twenty-seven publications (including 2277 tumours in 2044 participants) were included in the systematic review, and nine in the meta-analysis.

Results

Forest plots of sensitivity and specificity were produced for CT (seven records, 1118 participants), contrast-enhanced ultrasound (seven records, 197 participants), [^99mTc]Tc-sestamibi SPECT/CT (five records, 263 participants), MRI (three records, 220 participants), [¹⁸F]FDG PET (four records, 43 participants), [⁶⁸Ga]Ga-PSMA-11 PET (one record, 27 participants) and [¹¹¹In]In-girentuximab SPECT/CT (one record, eight participants). Meta-analysis returned summary estimates of sensitivity and specificity for [^99mTc]Tc-sestamibi SPECT/CT of 88.6% (95% CI 82.7%–92.6%) and 77.0% (95% CI 63.0%–86.9%) and for [¹⁸F]FDG PET 53.5% (95% CI 1.6%–98.8%) and 62.5% (95% CI 14.0%–94.5%), respectively. A comparison hierarchical summary receiver operating characteristic (HSROC) model did not converge. Meta-analysis was not performed for other imaging due to different thresholds for test positivity.

Conclusion

The optimal imaging strategy for T1 renal masses is not clear. [^99mTc]Tc-sestamibi SPECT/CT is an emerging tool, but further studies are required to inform its role in clinical practice. The field would benefit from standardisation of diagnostic thresholds for CT, MRI and contrast-enhanced ultrasound to facilitate future meta-analyses.

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