Department of Ultrasound, Wuxi People's Hospital of Nanjing Medical University, 299 Qingyang Road, Wuxi, 214023, Jiangsu, People's Republic of China.
Surg Endosc. 2018 Apr;32(4):2067-2075. doi: 10.1007/s00464-017-5903-4. Epub 2017 Dec 21.
To review the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) used to detect residual or recurrent liver tumors after radiofrequency ablation (RFA). This technique uses contrast-enhanced computer tomography or/and contrast-enhanced magnetic resonance imaging as the gold standard of investigation.
MEDLINE, EMBASE, and COCHRANE were systematically searched for all potentially eligible studies comparing CEUS with the reference standard that follows RFA. Risk of bias and applicability concerns were addressed by adopting the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled point estimates for sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios (DOR) with 95% CI were computed before plotting the sROC (summary receiver operating characteristic) curve. Meta-regression and subgroup analysis were used to identify the source of the heterogeneity that was detected. Publication bias was evaluated using Deeks' funnel plot asymmetry test.
Ten eligible studies on 1162 lesions that occurred between 2001 and 2016 were included in the final analysis. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable. The pooled sensitivity and specificity of CEUS in detecting residual or recurrent liver tumors had the following values: 0.90 (95% CI 0.85-0.94) and 1.00 (95% CI 0.99-1.00), respectively. Overall DOR was 420.10 (95% CI 142.30-1240.20). The sources of heterogeneity could not be precisely identified by meta-regression or subgroup analysis. No evidence of publication bias was found.
This study confirmed that CEUS exhibits high sensitivity and specificity in assessing therapeutic responses to RFA for liver tumors.
回顾对比增强超声（CEUS）用于检测射频消融（RFA）后残留或复发性肝肿瘤的诊断准确性。该技术使用对比增强计算机断层扫描和/或对比增强磁共振成像作为调查的金标准。
系统地检索了 MEDLINE、EMBASE 和 COCHRANE 数据库，以查找所有比较 CEUS 与 RFA 后参考标准的潜在合格研究。采用诊断准确性研究质量评估工具（QUADAS-2）评估偏倚风险和适用性问题。计算了汇总受试者工作特征（sROC）曲线前的敏感性、特异性、阳性和阴性似然比以及诊断比值比（DOR）的汇总点估计值，置信区间为 95%。使用 Meta 回归和亚组分析来确定检测到的异质性的来源。使用 Deeks 漏斗图不对称检验评估发表偏倚。
最终分析纳入了 10 项研究，共 1162 个病变，发生在 2001 年至 2016 年之间。通过 QUADAS-2 工具评估的纳入研究的质量被认为是合理的。CEUS 检测残留或复发性肝肿瘤的汇总敏感性和特异性分别为 0.90（95%CI 0.85-0.94）和 1.00（95%CI 0.99-1.00）。总体 DOR 为 420.10（95%CI 142.30-1240.20）。Meta 回归或亚组分析无法准确确定异质性的来源。未发现发表偏倚的证据。
本研究证实，CEUS 在评估肝肿瘤 RFA 治疗反应方面具有较高的敏感性和特异性。
