Abstract
We assessed the clinical utility of contrast‐enhanced ultrasonography (CEUS) in the diagnosis of benign and malignant small renal masses using a meta‐analysis of diagnostic test. We performed a comprehensive online search in the following database including PubMed, Embase, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure from the inception to August 25, 2019. the following index were calculated for assessing the diagnostic ability, including sensitivity, specificity, diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), area under the curve (AUC) with 95% confidence intervals (CIs). Seventeen studies were included in the qualitative and quantitative analyses. The overall sensitivity was 0.93 with 95% CI of 0.88‐0.95. The specificity was 0.71 and the 95% CI was 0.60‐0.80. The pooled AUC was 0.91 (95% CI: 0.88‐0.93). The diagnostic odds ratio was 31 (95% CI: 21‐45). The NLR and PLR were 0.10 (95% CI: 0.07‐0.15) and 3.2(95% CI: 2.3‐4.4), respectively. There is a slight heterogeneity within studies. The subgroup analysis was also performed. For retrospective and perspective, the sensitivity and specificity were 0.93, 0.92 and 0.71, 0.73; For different diameter lesions, the sensitivity and specificity were 0.93, 0.94 and 0.64, 0.74; For sample size (≤median vs. >median), the sensitivity and specificity were 0.94, 0.93 and 0.67, 0.77. The Deek's funnel plot asymmetry test in indicated no publication bias. The CEUS have a high diagnostic ability in differentiating benign and malignant small renal masses among Asian population.
Highlights
The small renal masses were defined that the diameter of renal masses measured by enhanced image was equal or less than 4 cm.[1]
The negative likelihood ratio (NLR) and positive likelihood ratio (PLR) were 0.10 and 3.2(95% confidence intervals (CIs): 2.3‐4.4), respectively
For all analysis the following parameters were calculated for assessing the diagnostic ability, including sensitivity, specificity, diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), area under the curve (AUC) with 95% confidence intervals (CIs).[15,16,17,18]
Summary
The small renal masses were defined that the diameter of renal masses measured by enhanced image was equal or less than 4 cm.[1]. Some small malignant renal tumors had metastasized at a relatively small volume, and the malignancy gradually increased with the increase in rumor diameter.[7] the early detection and timely treatment for small renal carcinoma become one of the most factors in improving curative effect and survival status. The methods of detecting small renal masses included computed tomography (CT), magnetic resonance imaging (MRI), conventional ultrasound (CUS), and contrast‐enhanced ultrasound (CEUS).[8] The CT and MRI have high sensitivity and specificity in detecting renal tumor. The CEUS has many advantages such as relative low cost, higher sensitivity and specificity than ordinary ultrasound, and similar detection ability as the CT. There is a lack of comprehensive comparative study on the detection ability of contrast‐enhanced ultrasonography for small renal masses with large sample sizes. We performed a systematical search, pooled the extracted data and presented more accurate estimations for the diagnostic ability of CEUS for small renal masses
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