Niu Yonghua, Huang Tairi, Lian Feng, Li Fenghua
Department of Ultrasound, Renji Hospital, Medical College of Shanghai Jiaotong University, Dongfang Road No.1630, Shanghai, 200001, China.
Tumour Biol. 2013 Dec;34(6):3667-74. doi: 10.1007/s13277-013-0948-z. Epub 2013 Jun 27.
The aim of this study is to determine the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) for diagnosis of small (≤ 2 cm in diameter) hepatocellular carcinoma (HCC) through a meta-analysis of published studies. A comprehensive literature search of PubMed, Embase, Web of Science, and China BioMedicine databases was conducted on articles published before 1 March 2013. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analyses were performed using Meta-Disc version 1.4 and STATA version 12.0 softwares. Fifteen studies were included with a total of 908 cirrhotic patients with 1,032 small hepatic nodules. All lesions were histologically confirmed through liver biopsies after CEUS. The pooled sensitivity was 0.81 (95% CI = 0.78-0.85); the pooled specificity was 0.86 (95% CI = 0.82-0.89). The pooled positive LR was 5.90 (95% CI = 3.90-8.94); the pooled negative LR was 0.20 (95% CI = 0.14-0.29). The pooled DOR was 37.07 (95% CI = 24.79-55.44). The area under the SROC curve was 0.93 (SE = 0.01). Meta-regression analysis showed that the number of lesions may be a major source of heterogeneity. No publication bias was detected in this meta-analysis. This meta-analysis indicates that CEUS is a useful diagnostic tool with high sensitivity and specificity for identifying small HCC.
本研究旨在通过对已发表研究的荟萃分析，确定超声造影（CEUS）对直径≤2cm的小肝细胞癌（HCC）的诊断准确性。对PubMed、Embase、Web of Science和中国生物医学数据库进行了全面的文献检索，纳入2013年3月1日前发表的文章。汇总所选研究的数据，得出汇总敏感性、特异性、阳性和阴性似然比（LR）、诊断比值比（DOR）以及受试者工作特征（SROC）曲线。使用Meta-Disc 1.4版和STATA 12.0版软件进行统计分析。纳入15项研究，共908例肝硬化患者，有1032个小肝结节。所有病变在CEUS检查后均通过肝活检进行组织学确诊。汇总敏感性为0.81（95%CI=0.78-0.85）；汇总特异性为0.86（95%CI=0.82-0.89）。汇总阳性LR为5.90（95%CI=3.90-8.94）；汇总阴性LR为0.20（95%CI=0.14-0.29）。汇总DOR为37.07（95%CI=24.79-55.44）。SROC曲线下面积为0.93（SE=0.01）。Meta回归分析表明，病变数量可能是异质性的主要来源。本荟萃分析未检测到发表偏倚。该荟萃分析表明，CEUS是一种用于识别小肝癌的具有高敏感性和特异性的有用诊断工具。
