Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan.
Dig Endosc. 2019 Mar;31(2):125-133. doi: 10.1111/den.13290. Epub 2019 Jan 15.
Current imaging modalities are limited in their ability to distinguish pancreatic cancer (PC) from non-neoplastic pancreatic lesions. The diagnostic use of contrast-enhanced endoscopic ultrasonography (CE-EUS) has increased, and its utility has been reported. Recently, contrast-enhanced harmonic EUS (CH-EUS) was reported to facilitate imaging of parenchymal perfusion and microvessels in pancreatobiliary diseases, leading to a high diagnostic accuracy for PC. The present meta-analysis aims to investigate the usefulness of CH-EUS with enhancement pattern for PC diagnosis.
A systematic meta-analysis of all potentially relevant articles identified in PubMed, the Cochrane library, and Medline was carried out. Fixed-effects or random-effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence interval (CI).
The study enrolled 887 patients from nine eligible studies. Pooled estimates of sensitivity and specificity were 93% (95% CI, 0.91-0.95) and 80% (95% CI, 0.75-0.85), respectively. Subgroup analyses were carried out on the main results after excluding two outliers. Area under summary receiver operating characteristics curve was 0.97. No publication bias was found using funnel plots. No significant relationship was found between the diagnostic odds ratios and the characteristics of the studies including continent and contrast agent.
This meta-analysis showed that CH-EUS with qualitative analysis of enhancement pattern is useful for the diagnosis of PC, and has high sensitivity and accuracy, regardless of the type of contrast agent used. This modality may provide improved diagnostic accuracy for PC in clinical practice.
目前的成像方式在区分胰腺癌（PC）和非肿瘤性胰腺病变方面能力有限。对比增强内镜超声（CE-EUS）的诊断应用有所增加，其效用也已有报道。最近，对比增强谐波超声（CH-EUS）被报道有助于显示胰胆管疾病的实质灌注和微血管，从而提高了对 PC 的诊断准确性。本荟萃分析旨在研究增强模式的 CH-EUS 在 PC 诊断中的作用。
对 PubMed、Cochrane 图书馆和 Medline 中所有潜在相关文章进行了系统的荟萃分析。使用固定效应或随机效应模型，研究了汇总的敏感性、特异性、阳性似然比和阴性似然比及其 95%置信区间（CI）。
该研究纳入了来自 9 项合格研究的 887 名患者。汇总的敏感性和特异性估计值分别为 93%（95%CI，0.91-0.95）和 80%（95%CI，0.75-0.85）。在排除两个异常值后，对主要结果进行了亚组分析。汇总受试者工作特征曲线下面积为 0.97。漏斗图未发现发表偏倚。未发现诊断比值比与包括大洲和对比剂在内的研究特征之间存在显著关系。
本荟萃分析表明，定性分析增强模式的 CH-EUS 有助于 PC 的诊断，具有较高的敏感性和准确性，而与使用的对比剂类型无关。这种方法可能会为临床实践中 PC 的诊断提供更高的准确性。
