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Review
. 2022 Feb 25;10(4):E369-E377.
doi: 10.1055/a-1782-5033. eCollection 2022 Apr.

Comparison of endoscopic ultrasonography with and without contrast enhancement for characterization of pancreatic tumors: a meta-analysis

Yasunobu Yamashita  1 , Toshio Shimokawa  2 , Reiko Ashida  1 , Bertrand Napoléon  3 , Andrea Lisotti  4 , Pietro Fusaroli  4 , Rodica Gincul  3 , Christoph F Dietrich  5 , Shunsuke Omoto  6 , Masayuki Kitano  1
Affiliations
Review

Comparison of endoscopic ultrasonography with and without contrast enhancement for characterization of pancreatic tumors: a meta-analysis

Yasunobu Yamashita et al. Endosc Int Open. .

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.

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Conflict of interest statement

Competing interests Kitano and Napoléon have received honoraria from Olympus Corporation for presentations at conferences. Dr. Dietrich has received honoraria from Hitachi and Pentax Corporations for presentations at conferences.

Figures

Fig. 1
Fig. 1
Flowchart showing the study selection process.
Fig. 2
Fig. 2
Quality assessment of the studies according to QUADAS-2. Red, high risk of bias; green: unclear risk of bias; blue, low risk of bias.
Fig. 3
Fig. 3
Forest plots of pooled sensitivity for characterization of pancreatic tumors with contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS).
Fig. 4
Fig. 4
Forest plots of pooled specificity for characterization of pancreatic tumors on contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS).
Fig. 5
Fig. 5
Forest plots of the pooled positive likelihood ratios on contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS).
Fig. 6
Fig. 6
Forest plots of the pooled negative likelihood ratios on contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS).
Fig. 7
Fig. 7
Summary receiver operating characteristics (SROC) curves for accuracy of characterization for pancreatic tumors with contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS). AUC, area under the curve; SE, standard error; Q, the point at which sensitivity and specificity are equal.
Fig. 8
Fig. 8
Forest plot of odds ratios for characterization for pancreatic tumors by contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS).
Fig. 9
Fig. 9
Comparison of the accuracy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and plain EUS (P-EUS) for the characterization of pancreatic tumors.
Fig. 10
Fig. 10
Funnel plot to evaluate publication bias in the included studies.
See this image and copyright information in PMC

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