Contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses: a meta-analysis / 中华消化内镜杂志

ABSTRACT

Objective To assess the accuracy of contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses.Methods We systematically searched the Medline,PubMed,Web of Science,Embase,Cochrane Central Trials,CNKI and VIP databases for relevant studies published.Study selection,quality assessment and data extraction were performed by two reviewers independently.Meta-Disc (version 1.4) software was used to perform this meta-analysis for sensitivity,specificity,positive likelihood ratio (LR),and negative LR.Pooling results were derived by using the fixed-effect model when significant heterogeneity was not present.The random-effect model was applied otherwise.A summary receiver-operating characteristic (SROC) curve was constructed.Furthermore,to explore the potential sources of heterogeneity,we used meta-regression to estimate the effect of the following characteristics of the studies on the diagnostic accuracy of contrast-enhanced EUS.In addition,the outliers were identified with the method described by Deville and a subgroup analysis was performed by excluding the outliers.We used Stata statistical software (version 10.0) to assess the publication bias with the Begg-Mazumdar indictor and Harbord-Egger indictor.Results Twelve studies involving 1139 patients were included.The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic masses was 94％ (95％ CI,0.91 ～0.95),the specificity was 89％ (95 ％ CI,0.85 ～ 0.92),the positive LR was 8.09 (95 ％ CI,4.47 ～ 14.64),and the negative LR was 0.08 (95％ CI,0.06 ～ 0.10).The area under the curve (AUC) under SROC was 0.9732 (SE =0.02).The subgroup analysis by excluding two outliers provided a sensitivity of 93％ (95％ CI,0.91 ～ 0.95) and a specificity of 93％ (95％ CI,0.89 ～ 0.95).Additionally,the subgroup analysis showed that the heterogeneities were eliminated in pooled estimates when the outliers were excluded and the AUC under SROC was 0.9745 (SE =0.02).Moreover,no significant publication bias was found with the Begg-Mazumdar indictor (P =0.244) or the Harbord-Egger indictor (P =0.442).Conclusion Contrastenhanced EUS is a valuable method in the differential diagnosis of pancreatic masses.