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DOI: 10.1055/a-1782-5033
Comparison of endoscopic ultrasonography with and without contrast enhancement for characterization of pancreatic tumors: a meta-analysis
Abstract
Background and study aims Endoscopic ultrasonography (EUS) is a reliable and efficient modality for detecting pancreatic tumors; however, plain EUS (P-EUS) is limited with respect to characterization of pancreatic tumors. Recently, the use of contrast-enhanced harmonic EUS (CH-EUS) has increased, and its utility for characterization of pancreatic tumors has been reported. This meta-analysis compares the diagnostic ability of P-EUS with that of CH-EUS for characterization of pancreatic tumors.
Methods A systematic meta-analysis of all potentially relevant articles in PubMed, the Cochrane library, and Google Scholar databases was performed. Fixed effects or random effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio, with 95 % confidence intervals (CIs).
Results This meta-analysis included 719 patients who underwent CH-EUS and 723 who underwent P-EUS, from six eligible studies. The pooled estimates of sensitivity, specificity, and diagnostic odds ratio were 93 % (95 % CI, 0.90–0.95), 80 % (95 % CI, 0.75–0.85), and 57.9 (95 % CI, 25.9–130), respectively, for CH-EUS, and 86 % (95 % CI, 0.82–0.89), 59 % (95 % CI, 0.52–0.65), and 8.3 (95 % CI, 2.8–24.5) for P-EUS. The areas under the summary receiver operating characteristics curves for CH-EUS and P-EUS were 0.96 and 0.80, respectively. The diagnostic odds ratio for pancreatic cancer was 2.98 times higher on CH-EUS than on P-EUS (P = 0.03). Funnel plots demonstrated no publication bias.
Conclusions This meta-analysis demonstrates that CH-EUS has higher diagnostic accuracy for pancreatic cancer than P-EUS, and is thus a valuable tool for characterization of pancreatic tumors.
Publikationsverlauf
Eingereicht: 08. Mai 2021
Angenommen nach Revision: 27. September 2021
Accepted Manuscript online:
25. Februar 2022
Artikel online veröffentlicht:
14. April 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 American Cancer Society. Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017
- 2 The Editorial Board of the Cancer Statics in Japan, Foundation for Promotion of Cancer Research. Cancer Statics in Japan-2015. Tokyo, Japan: FPCR c/o National Cancer Center; 2016: 1-129
- 3 Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10: 10-27
- 4 Ahmad NA, Kochman ML, Lewis JD. et al. Endosonography is superior to angiography in the preoperative assessment of vascular involvement among patients with pancreatic carcinoma. J Clin Gastroenterol 2001; 32: 54-58
- 5 DeWitt J, Devereaux B, Chriswell M. et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 2004; 141: 753-763
- 6 Krishna SG, Rao BB, Ugbarugba E. et al. Diagnostic performance of endoscopic ultrasound for detection of pancreatic malignancy following an indeterminate multidetector CT scan: a systemic review and meta-analysis. Surg Endosc 2017; 31: 4558-4567
- 7 Lee TY, Cheon YK, Shim CS. et al. Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating solid tumors of pancreas: A single-center experience in Korea. Gut Liver 2013; 7: 559-604
- 8 Dietrich CF, Sahai AV, DʼOnofrio M. et al. Differential diagnosis of small solid pancreatic tumors. Gastrointest Endosc 2016; 84: 933-940
- 9 Kitano M, Kudo M, Yamao K. et al. Characterization of small solid tumors in the pancreas: The value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol 2012; 107: 303-310
- 10 Yamashita Y, Tanioka K, Kawaji Y. et al. Utility of contrast-enhanced harmonic endoscopic ultrasonography for early diagnosis of small pancreatic cancer. Diagnostics 2020; 10: 23
- 11 Yamashita Y, Shimokawa T, Napoléon B. et al. Value of contrast-enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta-analysis. Dig Endosc 2019; 31: 125-133
- 12 He XK, Ding Y, Sun LM. Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis. Oncotarget 2017; 8: 66392-66401
- 13 Gong TT, Hu DM, Zhu Q. Contrast-enhanced EUS for differential diagnosis of pancreatic mass tumors: a metaanalysis. Gastrointest Endosc 2012; 76: 301-309
- 14 Mei S, Wang M, Sun L. Contrast-enhanced EUS for differential diagnosis of pancreatic masses: a meta-analysis. Gastroenterol Res Pract 2019; 6: 1670183
- 15 Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1995; 22: 719-748
- 16 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
- 17 Fusaroli P, Spada A, Mancino MG. et al. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol 2010; 8: 629-634
- 18 Uekitani K, Kaino S, Harima H. et al. Efficacy of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic ductal carcinoma. Saudi J Gastoroenterol 2016; 22: 198-202
- 19 Bunganič B, Laclav M, Dvořáková T. et al. Accuracy of EUS and CEH EUS for the diagnosis of pancreatic tumours. Scand J Gastroenterol 2018; 53: 1411-1417
- 20 Harmsen FR, Domagk D, Dietrich CF. et al. Discriminating chronic pancreatitis from pancreatic cancer: Contrast-enhanced EUS and multidetector computed tomography in direct comparison. Endosc Ultrasound 2018; 7: 395-403
- 21 Hocke M, Ignee A, Dietrich CF. Advanced endosonographic diagnostic tools for discrimination of focal chronic pancreatitis and pancreatic carcinoma -- elastography, contrast enhanced high mechanical index (CEHMI) and low mechanical index (CELMI) endosonography in direct comparison. Z Gastroenterol 2012; 50: 199-203
- 22 Omoto S, Kitano M, Fukasawa M. et al. Tissue harmonic versus contrast-enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic tumors: a prospective multicenter study. Dig Endosc 2021;
- 23 Moriysu F, Itoh K. Efficacy of perflubutane microbubble-enhanced ultrasound in the characterization and detection of focal liver tumors: phase 3 multicenter clinical trial. AJR Am J Roentgenol 2009; 193: 86-95
- 24 Kanno A, Yasuda I, Irisawa A. et al. Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study. Dig Endosc 2021; 7: 1146-1157
- 25 Yamashita Y, Kitano M, Ashida R. Value of endoscopy for early diagnosis of pancreatic carcinoma. Dig Endosc 2020; 32: 27-36
- 26 Siddiqui AA, Brown LJ, Hong SK. et al. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasound-guided fine needle aspiration. Dig Dis Sci 2011; 56: 3370-3375
- 27 Gincul R, Palazzo M, Pujol B. et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy 2014; 46: 373-379