Mei Sibin, Wang Mengyu, Sun Leimin
Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou 310016, China.
Gastroenterol Res Pract. 2019 Mar 6;2019:1670183. doi: 10.1155/2019/1670183. eCollection 2019.
Though methods for the diagnosis of pancreatic masses are various, such as ultrasonography (US), computed tomography (CT), endoscopic ultrasonography (EUS), and contrast-enhanced computed tomography (CE-CT), their sensitivity, specificity, and accuracy are not quite satisfying. Contrast-enhanced endoscopic ultrasonography (CE-EUS), as a new technique, has its own unique advantages in diagnosing pancreatic disease. However, its sensitivity, specificity, and accuracy are still controversial.
To evaluate the accuracy of CE-EUS for differential diagnosis between benign and malignant pancreatic mass lesions.
Eighteen relevant articles systemically searched from PubMed, Web of Science, Ovid, Scopus, and MEDLINE were selected. The pooled results were calculated in a fixed effects model.
The pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio, diagnostic odds ratio (OR), and summary receiver operating characteristic (SROC) curve.
The pooled sensitivity, specificity, and diagnostic odds ratio of CE-EUS for the differential diagnosis of pancreatic adenocarcinomas were 0.91 (95% confidence interval (CI), 0.89-0.93), 0.86 (95% CI, 0.83-0.89), and 69.50 (95% CI, 48.89-98.80), respectively. The SROC area under the curve was 0.9545. The subgroup analysis based on excluding the outliers showed that the heterogeneity was eliminated and the pooled sensitivity and specificity were 0.92 (95% CI, 0.90-0.93) and 0.87 (95% CI, 0.84-0.89), respectively. The SROC area under the curve was 0.9569.
CE-EUS is a useful method to distinguish pancreatic adenocarcinoma from other pancreatic diseases. Compared with EUS elastography, it has higher specificity. However, it is still not superior to pathological diagnosis for the identification of pancreatic carcinomas.
虽然胰腺肿块的诊断方法多种多样，如超声检查（US）、计算机断层扫描（CT）、内镜超声检查（EUS）和对比增强计算机断层扫描（CE-CT），但其敏感性、特异性和准确性并不十分令人满意。对比增强内镜超声检查（CE-EUS）作为一项新技术，在胰腺疾病诊断方面具有独特优势。然而，其敏感性、特异性和准确性仍存在争议。
评估CE-EUS对胰腺良恶性肿块病变进行鉴别诊断的准确性。
从PubMed、科学网、Ovid、Scopus和MEDLINE系统检索出18篇相关文章。采用固定效应模型计算合并结果。
合并敏感性、特异性、阳性似然比（LR）、阴性似然比、诊断比值比（OR）和汇总受试者工作特征（SROC）曲线。
CE-EUS对胰腺腺癌鉴别诊断的合并敏感性、特异性和诊断比值比分别为0.91（95%置信区间（CI），0.89-0.93）、0.86（95%CI，0.83-0.89）和69.50（95%CI，48.89-98.80）。曲线下SROC面积为0.9545。基于排除离群值的亚组分析显示异质性被消除，合并敏感性和特异性分别为0.92（95%CI，0.90-0.93）和0.87（95%CI，0.84-0.89）。曲线下SROC面积为0.9569。
CE-EUS是区分胰腺腺癌与其他胰腺疾病的有用方法。与EUS弹性成像相比，它具有更高的特异性。然而，在胰腺癌的鉴别诊断中，它仍不优于病理诊断。
