Abstract
Background Though methods for the diagnosis of pancreatic masses are various, such as ultrasonography (US), computed tomography (CT), endoscopic ultrasonography (EUS), and contrast-enhanced computed tomography (CE-CT), their sensitivity, specificity, and accuracy are not quite satisfying. Contrast-enhanced endoscopic ultrasonography (CE-EUS), as a new technique, has its own unique advantages in diagnosing pancreatic disease. However, its sensitivity, specificity, and accuracy are still controversial. Objective To evaluate the accuracy of CE-EUS for differential diagnosis between benign and malignant pancreatic mass lesions. Design Eighteen relevant articles systemically searched from PubMed, Web of Science, Ovid, Scopus, and MEDLINE were selected. The pooled results were calculated in a fixed effects model. Main Outcome Measurement The pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio, diagnostic odds ratio (OR), and summary receiver operating characteristic (SROC) curve. Results The pooled sensitivity, specificity, and diagnostic odds ratio of CE-EUS for the differential diagnosis of pancreatic adenocarcinomas were 0.91 (95% confidence interval (CI), 0.89-0.93), 0.86 (95% CI, 0.83-0.89), and 69.50 (95% CI, 48.89-98.80), respectively. The SROC area under the curve was 0.9545. The subgroup analysis based on excluding the outliers showed that the heterogeneity was eliminated and the pooled sensitivity and specificity were 0.92 (95% CI, 0.90-0.93) and 0.87 (95% CI, 0.84-0.89), respectively. The SROC area under the curve was 0.9569. Conclusion CE-EUS is a useful method to distinguish pancreatic adenocarcinoma from other pancreatic diseases. Compared with EUS elastography, it has higher specificity. However, it is still not superior to pathological diagnosis for the identification of pancreatic carcinomas.
Highlights
As the fourth leading cause of cancer-related death in Western countries [1], pancreatic cancer remains a big concern and health burden for both the government and individuals
Considering its higher accuracy compared with computed tomography (CT) and noninvasive characteristic compared with CE-FNA, CE-endoscopic ultrasonography (EUS) should be an important part in the pancreatic mass diagnosis algorithm
If patients are presented with negative CT results but still strongly suspicious of pancreatic mass or patients are presented with ambiguous CT results and need further confirmation, Contrast-enhanced endoscopic ultrasonography (CE-EUS) should be the choice
Summary
As the fourth leading cause of cancer-related death in Western countries [1], pancreatic cancer remains a big concern and health burden for both the government and individuals. To improve the early diagnostic rate of pancreatic cancer, early detection, and differential diagnosis of pancreatic masses are critical. Current methods available for differential diagnosis of pancreatic masses are various, among which EUS, contrast-enhanced ultrasonography (CE-US), CE-CT, CE elastography, endoscopic ultrasonography fine-needle aspiration (EUS-FNA), and CE-EUS are commonly used in recent years. Though methods for the diagnosis of pancreatic masses are various, such as ultrasonography (US), computed tomography (CT), endoscopic ultrasonography (EUS), and contrast-enhanced computed tomography (CE-CT), their sensitivity, specificity, and accuracy are not quite satisfying. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio, diagnostic odds ratio (OR), and summary receiver operating characteristic (SROC) curve. The pooled sensitivity, specificity, and diagnostic odds ratio of CE-EUS for the differential diagnosis of pancreatic adenocarcinomas were 0.91 (95% confidence interval (CI), 0.89-0.93), 0.86 (95% CI, 0.83-0.89), and 69.50 (95% CI, 48.89-98.80), respectively. It is still not superior to pathological diagnosis for the identification of pancreatic carcinomas
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