Meta-analysis of contrast-enhanced ultrasound and contrast-enhanced harmonic endoscopic ultrasound for the diagnosis of gallbladder malignancy

Xue Liang,Xiang Jing

doi:10.1186/s12911-020-01252-5

Abstract

BackgroundThe diagnosis between benign and malignant gallbladder lesions is sometimes difficult. The objective of this study is to assess whether contrast-enhanced ultrasound (CEUS) and contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can be an accurate method for detecting gallbladder malignancy and to determine which imaging signs can be indicative of malignancy.MethodsA study search of PubMed, Elsevier, and Sciencedirect was performed in May 2019. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were used to examine the accuracy of CEUS and CH-EUS.ResultsTwenty-one studies were included in the meta-analysis. The pooled sensitivities of CEUS and CH-EUS were 0.81 (0.75–0.86) and 0.92 (0.86–0.95); the specificities were 0.94 (0.90–0.96) and 0.89 (0.69–0. 97); the DORs were 64 (32–127) and 89 (22–354); and the area under the SROC curves were 0.90 (0.87–0.92) and 0.92 (0.90–0.94). On CEUS, the diagnostic criterion for gallbladder malignancy according to four features were analyzed. Sensitivity and specificity were 0.75 (0.65–0.83) and 0.98 (0.85–1.00) for integrity of gallbladder wall; 0.69 (0.55–0.81) and 0.89 (0.77–0.95) for heterogeneous enhancement; 0.81 (0.71–0.88) and 0.88 (0.76–0.94) for irregular vessels; and 0.81 (0.66–0.91) and 0.75 (0.59–0.86) for washout time within 28 s. On CH-EUS, heterogeneous enhancement could be indicative of malignant lesions with a sensitivity of 0.94 (0.85–0.97); and the specificity was 0.92 (0.71–0.98).ConclusionsCEUS and CH-EUS are promising and reliable imaging modalities with a high sensitivity and specificity for the diagnosis of gallbladder malignancy. CH-EUS might be more sensitive than CEUS with a higher sensitivity. In addition, irregular tralesional vessels and washout time within 28 s on CEUS and heterogeneous enhancement on CH-EUS are indicative of malignancy. However, larger scale and well-designed studies are warranted to verify our results.

Highlights

The diagnosis between benign and malignant gallbladder lesions is sometimes difficult
Tralesional vascularity on contrast-enhanced ultrasound (CEUS) When we grouped characteristics by irregular vessels among 9 studies, we found the present of vascularity allowed a good diagnostic performance on identifying malignant GB lesions with the pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of 0.81(95% CI: 0.71–0.88, I2 = 69.26%), 0.88(95% CI: 0.76–0.94, I2 = 90.61%), and 30(95% CI: 17–53), respectively (Fig. 6)
When we focused on the blood flow and enhancement pattern on GB lesions, our result demonstrated that inhomogeneous enhancement on CEUS was not a promising indicator of malignancy with a relatively low sensitivity of 0.69, whereas the sensitivity through CHEUS was 0.94

Summary

Introduction

The diagnosis between benign and malignant gallbladder lesions is sometimes difficult. The objective of this study is to assess whether contrast-enhanced ultrasound (CEUS) and contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can be an accurate method for detecting gallbladder malignancy and to determine which imaging signs can be indicative of malignancy. In patients with early GB cancer, thickening of the wall may be the only detectable imaging sign; and US usually makes a poor diagnosis because wall thickening can occur in many benign lesions, such as adenomyomatosis [3, 4]. In order to improve diagnostic accuracy and reduce unnecessary surgery, it’s important to develop new US modalities to precisely differentiate malignant from benign lesions

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