Department of Ultrasound, Tianjin Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, No. 83, Jintang Road, Hedong District, Tianjin, 300170, China.
BMC Med Inform Decis Mak. 2020 Sep 17;20(1):235. doi: 10.1186/s12911-020-01252-5.
The diagnosis between benign and malignant gallbladder lesions is sometimes difficult. The objective of this study is to assess whether contrast-enhanced ultrasound (CEUS) and contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can be an accurate method for detecting gallbladder malignancy and to determine which imaging signs can be indicative of malignancy.
A study search of PubMed, Elsevier, and Sciencedirect was performed in May 2019. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were used to examine the accuracy of CEUS and CH-EUS.
Twenty-one studies were included in the meta-analysis. The pooled sensitivities of CEUS and CH-EUS were 0.81 (0.75-0.86) and 0.92 (0.86-0.95); the specificities were 0.94 (0.90-0.96) and 0.89 (0.69-0. 97); the DORs were 64 (32-127) and 89 (22-354); and the area under the SROC curves were 0.90 (0.87-0.92) and 0.92 (0.90-0.94). On CEUS, the diagnostic criterion for gallbladder malignancy according to four features were analyzed. Sensitivity and specificity were 0.75 (0.65-0.83) and 0.98 (0.85-1.00) for integrity of gallbladder wall; 0.69 (0.55-0.81) and 0.89 (0.77-0.95) for heterogeneous enhancement; 0.81 (0.71-0.88) and 0.88 (0.76-0.94) for irregular vessels; and 0.81 (0.66-0.91) and 0.75 (0.59-0.86) for washout time within 28 s. On CH-EUS, heterogeneous enhancement could be indicative of malignant lesions with a sensitivity of 0.94 (0.85-0.97); and the specificity was 0.92 (0.71-0.98).
CEUS and CH-EUS are promising and reliable imaging modalities with a high sensitivity and specificity for the diagnosis of gallbladder malignancy. CH-EUS might be more sensitive than CEUS with a higher sensitivity. In addition, irregular tralesional vessels and washout time within 28 s on CEUS and heterogeneous enhancement on CH-EUS are indicative of malignancy. However, larger scale and well-designed studies are warranted to verify our results.
良性和恶性胆囊病变的诊断有时较为困难。本研究旨在评估对比增强超声（CEUS）和对比增强谐波内镜超声（CH-EUS）是否可作为准确检测胆囊恶性肿瘤的方法，并确定哪些影像学特征可提示恶性肿瘤。
于 2019 年 5 月对 PubMed、Elsevier 和 Sciencedirect 进行了研究检索。使用汇总敏感性、特异性、诊断比值比（DOR）和汇总受试者工作特征（SROC）曲线来评估 CEUS 和 CH-EUS 的准确性。
共有 21 项研究纳入荟萃分析。CEUS 和 CH-EUS 的汇总敏感性分别为 0.81（0.75-0.86）和 0.92（0.86-0.95），特异性分别为 0.94（0.90-0.96）和 0.89（0.69-0.97），DOR 分别为 64（32-127）和 89（22-354），SROC 曲线下面积分别为 0.90（0.87-0.92）和 0.92（0.90-0.94）。在 CEUS 上，分析了胆囊恶性肿瘤的四项特征诊断标准。胆囊壁完整性的敏感性和特异性分别为 0.75（0.65-0.83）和 0.98（0.85-1.00）；异质性增强的敏感性和特异性分别为 0.69（0.55-0.81）和 0.89（0.77-0.95）；不规则血管的敏感性和特异性分别为 0.81（0.71-0.88）和 0.88（0.76-0.94）；28s 内洗脱时间的敏感性和特异性分别为 0.81（0.66-0.91）和 0.75（0.59-0.86）。在 CH-EUS 上，异质性增强的敏感性为 0.94（0.85-0.97），特异性为 0.92（0.71-0.98），提示恶性病变。
CEUS 和 CH-EUS 是有前途且可靠的影像学方法，具有较高的敏感性和特异性，可用于诊断胆囊恶性肿瘤。CH-EUS 的敏感性可能高于 CEUS，且敏感性更高。此外，CEUS 上不规则肿瘤血管和 28s 内洗脱时间，以及 CH-EUS 上异质性增强提示恶性肿瘤。但是，需要更大规模和精心设计的研究来验证我们的结果。
