Abstract
ObjectiveTo evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of benign and malignant ovarian tumors.MethodsThe scientific literature databases PubMed, Cochrane Library and CNKI were comprehensively searched for studies relevant to the use of CEUS technique for differential diagnosis of benign and malignant ovarian cancer. Pooled summary statistics for specificity (Spe), sensitivity (Sen), positive and negative likelihood ratios (LR+/LR−), and diagnostic odds ratio (DOR) and their 95%CIs were calculated. Software for statistical analysis included STATA version 12.0 (Stata Corp, College Station, TX, USA) and Meta-Disc version 1.4 (Universidad Complutense, Madrid, Spain).ResultsFollowing a stringent selection process, seven high quality clinical trials were found suitable for inclusion in the present meta-analysis. The 7 studies contained a combined total of 375 ovarian cancer patients (198 malignant and 177 benign). Statistical analysis revealed that CEUS was associated with the following performance measures in differential diagnosis of ovarian tumors: pooled Sen was 0.96 (95%CI = 0.92∼0.98); the summary Spe was 0.91 (95%CI = 0.86∼0.94); the pooled LR+ was 10.63 (95%CI = 6.59∼17.17); the pooled LR− was 0.04 (95%CI = 0.02∼0.09); and the pooled DOR was 241.04 (95% CI = 92.61∼627.37). The area under the SROC curve was 0.98 (95% CI = 0.20∼1.00). Lastly, publication bias was not detected (t = −0.52, P = 0.626) in the meta-analysis.ConclusionsOur results revealed the high clinical value of CEUS in differential diagnosis of benign and malignant ovarian tumors. Further, CEUS may also prove to be useful in differential diagnosis at early stages of this disease.
Highlights
Ovarian cancer is the fifth leading cause of cancer-related deaths among women in both developing and developed countries, and a substantial burden to global public health [1]
Statistical analysis revealed that contrast-enhanced ultrasonography (CEUS) was associated with the following performance measures in differential diagnosis of ovarian tumors: pooled Sen was 0.96 (95%CI = 0.92*0.98); the summary Spe was 0.91 (95%CI = 0.86*0.94); the pooled LR+ was 10.63 (95%CI = 6.59*17.17); the pooled LR− was 0.04 (95%CI = 0.02*0.09); and the pooled diagnostic odds ratio (DOR) was 241.04
Our results revealed the high clinical value of CEUS in differential diagnosis of benign and malignant ovarian tumors
Summary
Ovarian cancer is the fifth leading cause of cancer-related deaths among women in both developing and developed countries, and a substantial burden to global public health [1]. It is estimated that 50–60% of the deaths in ovarian cancer patients is linked to locally advanced disease [2]. Up to 10% of ovarian cancer patients are diagnosed with distant metastases, and the most common sites of organ metastases include breast, gastrointestinal tract and reproductive tract [2]. Despite the significant reduction in mortality rates of ovarian cancer patients over the past decades, the overall incidence rates continue to increase rapidly, even in countries that historically had low rates [3,4]. It is extremely important to find effective ways to diagnose ovarian cancers at early stages, before the disease spreads locally or metastasizes to distant organs [6]. Angiogenesis is a crucial factor in tumor cell proliferation and metastatic dissemination in various human cancers, including ovarian cancers, a reliable assessment of tumor angiogenesis and micro-vessel density (MVD) in ovarian cancers is critical for correct prognosis of patients [7,8]
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