Department of Ultrasound, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China.
Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, P.R. China.
Cancer Med. 2021 Dec;10(23):8288-8299. doi: 10.1002/cam4.4365. Epub 2021 Nov 1.
Now solid renal tumors ≤4 cm is the most common, especially the subtype of clear cell renal cell carcinoma (ccRCC) of malignant kidney tumors in clinical. However, there is not specific characteristics of contrast-enhanced ultrasound (CEUS) be recommended by the EFSUMB Guidelines in distinguish the essence of the kidney tumor with different sizes. Therefore, this meta-analysis aimed to assess the ability of CEUS to diagnose solid ccRCC (sccRCC) ≤4 cm. We comprehensively searched the Cochrane Library, Embase, PubMed, and Web of Science databases from their inception to 28 July 2020, for studies reporting the CEUS features of sccRCC lesions ≤4 cm. Additional articles were identified through the Chinese National Knowledge Infrastructure database. Studies were selected independently by two investigators and the relevant data were extracted. Discrepancies were resolved via discussion with the senior author. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and the sensitivity and specificity of each study were determined and plotted as a receiver operating characteristic curve. Ten studies were included in this meta-analysis. Hyperenhancement showed medium sensitivity (67%-89%) and specificity (42%-75%) for diagnosing sccRCC ≤4 cm, fast-in contrast agent and heterogeneous enhancement showed high diagnostic abilities (area under curve (AUC) 0.74-0.84), but the presence of a pseudocapsule and fast-out contrast agent had poor diagnostic ability (AUC <0.70). The combination of hyperenhancement and iso-enhancement showed high sensitivity (98%) for diagnosing sccRCC ≤4 cm. Hyperenhancement, fast-in contrast agent, and heterogeneous enhancement may be specific features that could help to identify sccRCC ≤4 cm, while the presence of a pseudocapsule and fast-out of contrast agent may have low diagnostic values. The combination of multiple indexes may improve the diagnostic value of CEUS for sccRCC ≤4 cm.
目前，直径≤4cm 的肾脏实体肿瘤最为常见，尤其是临床中恶性肾肿瘤的透明细胞肾细胞癌（ccRCC）亚型。然而，EFSUMB 指南并未推荐特定的对比增强超声（CEUS）特征来区分不同大小的肾肿瘤的本质。因此，这项荟萃分析旨在评估 CEUS 诊断直径≤4cm 的肾脏实体 ccRCC（sccRCC）的能力。我们全面检索了 Cochrane 图书馆、Embase、PubMed 和 Web of Science 数据库，检索时间从建库至 2020 年 7 月 28 日，以获取报告直径≤4cm 的 sccRCC 病变的 CEUS 特征的研究。还通过中国国家知识基础设施数据库识别了其他文章。由两名研究者独立选择研究，并提取相关数据。通过与资深作者讨论解决分歧。使用诊断准确性研究的质量评估-2 工具评估研究质量，并确定和绘制每个研究的敏感性和特异性作为接收者操作特征曲线。这项荟萃分析纳入了 10 项研究。对于诊断直径≤4cm 的 sccRCC，高增强显示出中等敏感性（67%-89%）和特异性（42%-75%），快速增强剂和异质性增强显示出较高的诊断能力（曲线下面积（AUC）0.74-0.84），但假性包膜和快速排出对比剂的存在诊断能力较差（AUC<0.70）。高增强和等增强的组合对诊断直径≤4cm 的 sccRCC 具有高敏感性（98%）。高增强、快速增强剂和异质性增强可能是有助于识别直径≤4cm 的 sccRCC 的特异性特征，而假性包膜和快速排出对比剂的存在可能具有较低的诊断价值。多个指标的组合可能会提高 CEUS 对直径≤4cm 的 sccRCC 的诊断价值。
