Mei Mei, Ye Ligang, Quan Juan, Huang Pintong
Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China,
Department of Emergency, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
Cancer Manag Res. 2018 Oct 26;10:4987-4997. doi: 10.2147/CMAR.S174751. eCollection 2018.
Contrast-enhanced ultrasound (CEUS) is a new technique used to distinguish benign from metastatic superficial lymph nodes (LNs) with variable accuracy. The objective of this meta-analysis was to evaluate the accuracy of CEUS for the diagnosis of superficial metastatic LNs.
A comprehensive literature search of PubMed, Web of Science, Medline, Embase, and the Cochrane Library was performed until April 2018. Nine articles reporting the diagnosis of 436 LNs by CEUS were investigated. The Mantel-Haenszel and DerSimonian-Laird methods were used to analyze pooled sensitivity, specificity, diagnostic OR, positive likelihood ratio (LR), and negative LR, and a summary receiver operating characteristic (SROC) curve was also evaluated.
The pooled sensitivity and specificity of CEUS for the differential diagnosis of benign and metastatic superficial LNs were 0.88 (95% CI, 0.83-0.92) and 0.80 (95% CI, 0.74-0.85), respectively. The pooled positive LR, negative LR, and diagnostic OR were 4.36 (95% CI, 2.38-7.99), 0.17 (95% CI, 0.10-0.31), and 32.75 (95% CI, 11.08-96.84), respectively. SROC area under the curve (AUC) was 0.9288. The subgroup analysis excluding outliers implied that the heterogeneity was almost eliminated, and the pooled sensitivity and specificity were 0.87 (95% CI, 0.81-0.92) and 0.79 (95% CI, 0.71-0.85), respectively. The SROC AUC was 0.8950.
CEUS, a novel imaging modality for the characterization of superficial LNs, shows a high sensitivity and specificity in the diagnosis of superficial metastatic LNs. The different diagnostic standards, contrast agents, and contrast modes contribute to a considerable level of heterogeneity among studies. A uniform standard for distinguishing between benign and metastatic LNs is needed for further clinical application.
超声造影（CEUS）是一种用于区分良性与转移性浅表淋巴结（LN）的新技术，其准确性各异。本荟萃分析的目的是评估CEUS诊断浅表转移性LN的准确性。
截至2018年4月，对PubMed、科学网、Medline、Embase和考克兰图书馆进行了全面的文献检索。对9篇报告通过CEUS诊断436个LN的文章进行了研究。采用Mantel-Haenszel法和DerSimonian-Laird法分析合并敏感度、特异度、诊断比值比、阳性似然比（LR）和阴性LR，并评估汇总的受试者工作特征（SROC）曲线。
CEUS鉴别良性与转移性浅表LN的合并敏感度和特异度分别为0.88（95%CI，0.83 - 0.92）和0.80（95%CI，0.74 - 0.85）。合并阳性LR、阴性LR和诊断比值比分别为4.36（95%CI，2.38 - 7.99）、0.17（95%CI，0.10 - 0.31）和32.75（95%CI，11.08 - 96.84）。SROC曲线下面积（AUC）为0.9288。排除异常值的亚组分析表明异质性几乎消除，合并敏感度和特异度分别为0.87（95%CI，0.81 - 0.92）和0.79（95%CI，0.71 - 0.85）。SROC AUC为0.8950。
CEUS作为一种用于浅表LN特征化的新型成像模式，在诊断浅表转移性LN方面显示出高敏感度和特异度。不同的诊断标准、造影剂和造影模式导致研究间存在相当程度的异质性。进一步临床应用需要区分良性与转移性LN的统一标准。
