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. 2018 Dec;16(6):5310-5314.
doi: 10.3892/etm.2018.6889. Epub 2018 Oct 22.

Contrast-enhanced ultrasound in the diagnosis of endometrial carcinoma: A meta-analysis

Jing Geng  1 , Jun Tang  1
Affiliations

Contrast-enhanced ultrasound in the diagnosis of endometrial carcinoma: A meta-analysis

Jing Geng et al. Exp Ther Med. 2018 Dec.

Abstract

The present study evaluated the diagnostic value of contrast-enhanced ultrasound (CEUS) in endometrial carcinoma (EC). Articles published until 31 January 2017 were retrieved from PubMed, EMBASE, Elsevier, Springer and Google scholar, with the following inclusion criteria: i) The accuracy (sensitivity and specificity) of CEUS in the diagnosis of EC was evaluated; ii) a gold standard was adopted to treat and confirm EC, including surgery, histopathology and appropriate follow-up (as included in the meta-analysis); iii) the data allowed for construction of a 2×2 table of positives, false-positives, negatives and false-negatives. Pooled estimates of sensitivity, specificity, risk ratios and diagnostic odds ratios (DOR) were calculated in the present meta-analysis of the accuracy of CEUS in diagnosing EC. The summary receiver-operating characteristics (sROC) curve was also constructed. Among the 93 relevant articles, 7 studies were finally selected according to the inclusion criteria with a sample size of n=275. The pooled sensitivity of CEUS in the diagnosis of EC was 84% [95% confidence interval (CI), 0.78-0.88], while the pooled specificity was 90% (95% CI, 0.86-0.92). The positive likelihood ratio (+LR) of CEUS was 8.0 (95% CI, 5.9-10.8) and the negative likelihood ratio (-LR) was 0.18 (95% CI, 0.13-0.25). The DOR was 44 (95% CI, 26-77). The area under the sROC curve was 0.93 with specificity of 0.90 (0.86-0.92) and sensitivity of 0.84 (0.78-0.88) for the summary operating point. Moderate heterogeneity was observed for sensitivity, specificity and DOR with I2 values of 32.56, 34.68 and 41.2%, respectively. No significant publication bias was observed for the DOR of CEUS. In conclusion, the present meta-analysis indicates that CEUS is valuable in the diagnosis of EC. Additional clinical data and studies are still required to confirm these results and to further develop the diagnostic application of CEUS in EC.

Keywords: contrast-enhanced ultrasound; diagnostic accuracy; endometrial carcinoma; meta-analysis.

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Figures

Figure 1.
Figure 1.
Search results. CEUS, contrast-enhanced ultrasound; EC, endometrial carcinoma.
Figure 2.
Figure 2.
(A) Forest plot of study-specific estimates of sensitivity (ratio with 95% confidence interval) of CEUS in the diagnosis of EC; (B) Forest plot of study-specific estimates of specificity (ratio with 95% confidence interval) of CEUS in the diagnosis of EC, every plot represents a related study, global results (pooled sensitivity/specificity) are presented at the bottom. The horizontal bars are the CI 95% ranges, and the squares within the bars are the estimate values. CEUS, contrast-enhanced ultrasound; EC, endometrial carcinoma; CI, confidence interval.
Figure 3.
Figure 3.
SROC curve of contrast-enhanced ultrasound in the diagnosis of endometrial carcinoma. Numbers represent the studies in Table I in the order that they are presented. SROC, summary receiver-operating characteristics; AUC, area under curve; SENS, sensitivity; SPEC, specificity.
Figure 4.
Figure 4.
Deek's funnel plot asymmetry test for publication bias for the 7 studies included in the meta-analysis. Numbers represent the studies in Table I in the order that they are presented. ESS, effective sample size.
Figure 5.
Figure 5.
Publication bias assessed by Review Manager for the 7 studies included in the meta-analysis.
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