Abstract

ObjectiveTo evaluate the overall performance of acoustic radiation force impulse imaging (ARFI) in differentiating between benign and malignant lymph nodes (LNs) by conducting a meta-analysis.MethodsPubMed, Embase, Web of Science, the Cochrane Library and the China National Knowledge Infrastructure were comprehensively searched for potential studies through August 13th, 2016. Studies that investigated the diagnostic power of ARFI for the differential diagnosis of benign and malignant LNs by using virtual touch tissue quantification (VTQ) or virtual touch tissue imaging quantification (VTIQ) were collected. The included articles were published in English or Chinese. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the methodological quality. The pooled sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated by means of a bivariate mixed-effects regression model. Meta-regression analysis was performed to identify the potential sources of between study heterogeneity. Fagan plot analysis was used to explore the clinical utilities. Publication bias was assessed using Deek’s funnel plot.ResultsNine studies involving 1084 LNs from 929 patients were identified to analyze in the meta-analysis. The summary sensitivity and specificity of ARFI in detecting malignant LNs were 0.87 (95% confidence interval [CI], 0.83–0.91) and 0.88 (95% CI, 0.82–0.92), respectively. The AUC was 0.93 (95% CI, 0.90–0.95). The pooled DOR was 49.59 (95% CI, 26.11–94.15). Deek’s funnel plot revealed no significant publication bias.ConclusionARFI is a promising tool for the differentiation of benign and malignant LNs with high sensitivity and specificity.

Highlights

  • The involment of lymph nodes (LNs) has been demonstrated to be an independent risk factor for local tumor recurrence [1, 2] as well as the most undesirable prognostic factor [3]

  • The summary sensitivity and specificity of Acoustic Radiation Force Impulse (ARFI) in detecting malignant LNs were 0.87 (95% confidence interval [CI], 0.83–0.91) and 0.88, respectively

  • Acoustic Radiation Force Impulse (ARFI) imaging is a novel elastography modality which is integrated into a conventional ultrasound machine and could assess the stiffness of tissues quantitatively without external compression in an operator-dependent manner [7]

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Summary

Introduction

The involment of lymph nodes (LNs) has been demonstrated to be an independent risk factor for local tumor recurrence [1, 2] as well as the most undesirable prognostic factor [3]. Acoustic Radiation Force Impulse (ARFI) imaging is a novel elastography modality which is integrated into a conventional ultrasound machine and could assess the stiffness of tissues quantitatively without external compression in an operator-dependent manner [7]. It could generate focused high-intensity, short-duration acoustic radiation forces by a ultrasound transducer and track the wave propagation as well as the localized displacements in a region of interest (ROI) to compute the value of shear wave velocity (SWV) expressed in the unit of m/s. Besides the SWV, VTIQ is capable of obtaining quality, travel time and displacement [9]

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