567 DIAGNOSTIC PERFORMANCE OF ULTRASOUND IN LOCALIZING NON-PALPABLE TESTES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

You have accessJournal of UrologyPediatrics: Imaging/Infections & Vesicoureteral Reflux1 Apr 2011567 DIAGNOSTIC PERFORMANCE OF ULTRASOUND IN LOCALIZING NON-PALPABLE TESTES: A SYSTEMATIC REVIEW AND META-ANALYSIS Gregory Tasian and Hillary Copp Gregory TasianGregory Tasian San Francisco, CA More articles by this author and Hillary CoppHillary Copp San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1377AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ultrasound is frequently obtained during the pre-surgical evaluation of boys with non-palpable undescended testes, but its clinical utility is uncertain. We performed a meta-analysis of published studies to determine the diagnostic performance of ultrasound in localizing non-palpable testes in pediatric patients. METHODS English language articles were identified by searching MEDLINE, EMBASE, and the Cochrane Library from inceptions to March 2010, and through manual bibliographic searches. We included observational studies of subjects less than 18 years who had pre-operative ultrasound evaluation for non-palpable testes, and whose testis position was determined by surgery. 12 (1.7%) studies met selection criteria, from which data on 591 testes was extracted. Articles were reviewed, selected, and abstracted by 2 independent reviewers. Data on testis location determined by ultrasound and surgery were extracted, from which ultrasound performance characteristics (true positives, false positives, false negatives, and true negatives) were derived. Meta-analysis was performed using a random-effects regression model; composite estimates of sensitivity, specificity, and likelihood ratios were calculated. RESULTS For localizing a non-palpable testis, ultrasound has a sensitivity of 45% (95% CI 29%–61%) and a specificity of 78% (95% CI 43%–94%). The positive and negative likelihood ratios are 1.48 (95% CI 0.54–4.03) and 0.79 (95% CI 0.46–1.35), respectively. A positive ultrasound increases and negative ultrasound decreases the probability that a non-palpable testis is located within the abdomen from 55% to 64% and 49%, respectively. Significant heterogeneity limited the precision of these estimates, which meta-regression revealed to be attributable to inter-study variability in the reporting of selection criteria, ultrasound methodology, and differences in the proportion of intra-abdominal testes. CONCLUSIONS Ultrasound does not reliably localize non-palpable undescended testes and, therefore, is not useful for surgical decision-making. We recommend against using ultrasound to evaluate boys with cryptorchidism, which could reduce annual health care expenditures by tens of millions of dollars. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e228-e229 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Tasian San Francisco, CA More articles by this author Hillary Copp San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...