Abstract
To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.
Highlights
Lymph node status is one of the major predictors of prognosis in patients with cancer (Innace et al, 2010;Deng et al, 2014; Fayaz et al, 2014; Gasparri et al, 2014; Kawada et al, 2014)
A flow chart Diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis for the study selection procedure is shown in Figure 1. of benign and malignant lymph nodes
B-mode and Color-Doppler sonography quantitative criteria used for determining the stage of25.0 were usually used as a first-line procedure to differentiate lymph nodes
Summary
Lymph node status is one of the major predictors of prognosis in patients with cancer (Innace et al, 2010;Deng et al, 2014; Fayaz et al, 2014; Gasparri et al, 2014; Kawada et al, 2014). A large number of modalities may be used to characterize lymph nodes, such as computed tomography, magnetic resonance imaging and gray scale ultrasound; these depend mainly on morphological characteristics for the identification of enlarged lymph nodes (Schröder et al, 2002; Riegger et al, 2012). Gray scale ultrasound combined with color Doppler ultrasonography can be applied to estimate the shape (L/T ratio), margins, internal structure and vascularization of lymph nodes (Ahuja et al, 2002; Stramare et al, 2004). Alternative diagnostic modalities include ultrasonography-guided fine needle aspiration biopsy (US-FNAB). Each of these various methods has its own limitations in the clinical diagnosis of lymph nodes, meriting the development of improved techniques. How to improve the diagnostic accuracy of enlarged lymph nodes and reduce unnecessary puncture of benign lymph nodes remains a challenge
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