Value of contrast‐enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta‐analysis

Abstract

Background Current imaging modalities are limited in their ability to distinguish pancreatic cancer (PC) from non‐neoplastic pancreatic lesions. The diagnostic use of contrast‐enhanced endoscopic ultrasonography (CE‐EUS) has increased, and its utility has been reported. Recently, contrast‐enhanced harmonic EUS (CH‐EUS) was reported to facilitate imaging of parenchymal perfusion and microvessels in pancreatobiliary diseases, leading to a high diagnostic accuracy for PC. The present meta‐analysis aims to investigate the usefulness of CH‐EUS with enhancement pattern for PC diagnosis. Methods A systematic meta‐analysis of all potentially relevant articles identified in PubMed, the Cochrane library, and Medline was carried out. Fixed‐effects or random‐effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence interval (CI). Results The study enrolled 887 patients from nine eligible studies. Pooled estimates of sensitivity and specificity were 93% (95% CI, 0.91–0.95) and 80% (95% CI, 0.75–0.85), respectively. Subgroup analyses were carried out on the main results after excluding two outliers. Area under summary receiver operating characteristics curve was 0.97. No publication bias was found using funnel plots. No significant relationship was found between the diagnostic odds ratios and the characteristics of the studies including continent and contrast agent. Conclusions This meta‐analysis showed that CH‐EUS with qualitative analysis of enhancement pattern is useful for the diagnosis of PC, and has high sensitivity and accuracy, regardless of the type of contrast agent used. This modality may provide improved diagnostic accuracy for PC in clinical practice.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…Yamashita et al [196] focused on CE-EUS and reported that its sensitivity and specificity for differentiating ductal carcinomas from the other tumors with CE-EUS were 93% and 80%, respectively. Regarding CE-EUS with Sonazoid, Kitano et al [197] reported that CE-EUS-depicted hypoenhancement diagnoses ductal carcinomas with a sensitivity and specificity of 95.1% (92.7%-96.7%) and 89.0% (83.0%-93.1%), respectively [197].…”

Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

“…The utility of quantitative evaluation of enhancement patterns using TICs in the differential diagnosis of pancreatic masses has been reported [23,[26][27][28][29]. In four meta-analyses, the pooled sensitivity and specificity of CE-EUS in the diagnosis of pancreatic cancer were 91-93% and 80-88%, respectively [30][31][32][33]. In addition, Yamashita et al [34] reported that the sensitivity of CE-EUS for the detection of pancreatic cancer in small pancreatic masses of 11-20 mm was significantly better than that of MDCT and MRI (95% compared to 78%, and 73%, respectively), and that the sensitivity of CE-EUS in pancreatic masses of 10 mm or less was also significantly better than that of MDCT (70% and 20%, respectively).…”

The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid

“…focused on CE-EUS and reported that its sensitivity and specificity for differentiating ductal carcinomas from the other tumors with CE-EUS were 93% and 80%, respectively. [ 196 ] Regarding CE-EUS with Sonazoid, Kitano et al . reported that CE-EUS-depicted hypoenhancement diagnoses ductal carcinomas with a sensitivity and specificity of 95.1% (92.7%–96.7%) and 89.0% (83.0%–93.1%), respectively.…”