RETRACTED ARTICLE: Meta-analysis of contrast-enhanced ultrasound and contrast-enhanced harmonic endoscopic ultrasound for the diagnosis of gallbladder malignancy

Abstract

Background 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. Methods A 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. Results Twenty-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). Conclusions CEUS 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.

A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study

“…Therefore, assessment of microvessels can provide valuable information that discriminates mural nodules from mucous clots in IPMN and gallbladder lesions from gallbladder sludge. Several studies report the utility of CE-EUS for differential diagnoses based on vascular assessment in pancreatobiliary diseases [11][12][13][14][15][16][17][18]. Here, we found that DFI-EUS (100%) was significantly superior to e-FLOW EUS (64%) for differential diagnosis with detecting vascularity.…”

“…Contrast-enhanced EUS (CE-EUS) increases the detectability of vessels and can overcome some of these limitations. Indeed, many studies demonstrate the utility of CE-EUS for diagnosis of pancreatobiliary lesions [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]; thus, the technique is used widely in the clinic. However, there are some problems.…”

Gallbladder polyp in children – a rare finding during ultrasound examination

“…CEUS may provide more useful information and improve diagnostic efficiency for gallbladder lesions than conventional ultrasound modalities ( 5 ) . CEUS is a promising imaging modality, with a high sensitivity for distinguishing gallbladder adenoma from adenocarcinoma ( 6 ) .…”

The Role of Endoscopic Ultrasound in the Diagnosis of Gallbladder Lesions

“…Xue Liang and Xiang Jing [56] reported a meta-analysis of contrast-enhanced ultrasound and contrast-enhanced harmonic EUS (CH-EUS) for the diagnosis of GB malignancy. The pooled sensitivities of CH-EUS and specificities were 0.92 and 0.89 (Table 6), respectively, in this meta-analysis.…”