Contrast‑enhanced harmonic endoscopic ultrasonography for the differential diagnosis of pancreatic masses: A systematic review and meta‑analysis

Li,Yang; Jin,Hailin; Liao,Dan; Qian,Bo; Zhang,Yeifei; Xu,Min; Han,Shutang

doi:10.3892/mco.2019.1908

Contrast‑enhanced harmonic endoscopic ultrasonography for the differential diagnosis of pancreatic masses: A systematic review and meta‑analysis

Authors:
- Yang Li
- Hailin Jin
- Dan Liao
- Bo Qian
- Yeifei Zhang
- Min Xu
- Shutang Han
View Affiliations

Affiliations: Gastroenterology Endoscopy Center, Affiliated Hospital of Nanjing Medical University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, Jiangsu 210029, P.R. China, Department of Gastroenterology, Shanghai First People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
Published online on: August 9, 2019 https://doi.org/10.3892/mco.2019.1908
Pages: 425-433

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Understanding the difference between malignant and benign pancreatic masses is critical in terms of diagnosis, although this is difficult to determine in clinical practice. The contrast‑enhanced harmonic endoscopic ultrasound (CH‑EUS) technique was introduced in 2010, although, to the best of the authors' knowledge, there has been no systematic review or meta‑analysis to date evaluating its diagnostic performance for the differentiation of pancreatic masses. The aim of the present study was to systematically evaluate the diagnostic performance of CH‑EUS for the differentiation of pancreatic masses. Search key words and inclusion and exclusion criteria were initially presented. Two independent authors read and extracted the relevant information from the included studies. Disagreements were resolved through discussion with another two experienced authors. Metadisc and Stata software were used for the meta‑analysis and the evaluation of bias. A total of 16 studies comprising 1,325 patients were included in this meta‑analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of CH‑EUS were used to distinguish between malignant and benign tumors, and the values obtained were 93% [95% confidence interval (CI): 91‑94%], 84% (95% CI: 80‑87%), 5.58 (95% CI: 3.90‑7.97), 0.09 (95% CI: 0.07‑0.11) and 72.56 (95% CI: 48.93‑107.60), respectively. The area under the summary receiver operating characteristic curve was determined to be 0.96. No publication bias was identified in this meta‑analysis. Taken together, these results confirm that CH‑EUS has a high accuracy rate for distinguishing between benign and malignant pancreatic space‑occupying lesions, and it may therefore be used as an effective diagnostic tool for pancreatic masses.

View Figures

View References

1	Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J and Jemal A: Global cancer statistics, 2012. CA Cancer J Clin. 65:87–108. 2015. View Article : Google Scholar : PubMed/NCBI
2	Hackeng WM, Hruban RH, Offerhaus GJ and Brosens LA: Surgical and molecular pathology of pancreatic neoplasms. Diagn Pathol. 11:472016. View Article : Google Scholar : PubMed/NCBI
3	Fusaroli P, Spada A, Mancino MG and Caletti G: Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol. 8:629–634.e1-e2. 2010. View Article : Google Scholar : PubMed/NCBI
4	Gincul R, Palazzo M, Pujol B, Tubach F, Palazzo L, Lefort C, Fumex F, Lombard A, Ribeiro D, Fabre M, et al: Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: A prospective multicenter trial. Endoscopy. 46:373–379. 2014. View Article : Google Scholar : PubMed/NCBI
5	Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA and Bossuyt PM; QUADAS-2 Group, : QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 155:529–536. 2011. View Article : Google Scholar : PubMed/NCBI
6	Napoleon B, Alvarez-Sanchez MV, Gincoul R, Pujol B, Lefort C, Lepilliez V, Labadie M, Souquet JC, Queneau PE, Scoazec JY, et al: Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: Results of a pilot study. Endoscopy. 42:564–570. 2010. View Article : Google Scholar : PubMed/NCBI
7	Seicean A, Badea R, Stan-Iuga R, Mocan T, Gulei I and Pascu O: Quantitative contrast-enhanced harmonic endoscopic ultrasonography for the discrimination of solid pancreatic masses. Ultraschall Med. 31:571–576. 2010. View Article : Google Scholar : PubMed/NCBI
8	Matsubara H, Itoh A, Kawashima H, Kasugai T, Ohno E, Ishikawa T, Itoh Y, Nakamura Y, Hiramatsu T, Nakamura M, et al: Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases. Pancreas. 40:1073–1079. 2011. View Article : Google Scholar : PubMed/NCBI
9	Romagnuolo J, Hoffman B, Vela S, Hawes R and Vignesh S: Accuracy of contrast-enhanced harmonic EUS with a second- generation perflutren lipid microsphere contrast agent (with video). Gastrointest Endosc. 73:52–63. 2011. View Article : Google Scholar : PubMed/NCBI
10	Kitano M, Kudo M, Yamao K, Takagi T, Sakamoto H, Komaki T, Kamata K, Imai H, Chiba Y, Okada M, et al: Characterization of small solid tumors in the pancreas: The value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol. 107:303–310. 2012. View Article : Google Scholar : PubMed/NCBI
11	Imazu H, Kanazawa K, Mori N, Ikeda K, Kakutani H, Sumiyama K, Hino S, Ang TL, Omar S and Tajiri H: Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma. Scand J Gastroenterol. 47:853–860. 2012. View Article : Google Scholar : PubMed/NCBI
12	Gheonea DI, Streba CT, Ciurea T and Săftoiu A: Quantitative low mechanical index contrast-enhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer. BMC Gastroenterol. 13:22013. View Article : Google Scholar : PubMed/NCBI
13	Lee TY, Cheon YK and Shim CS: Clinical role of contrast- enhanced harmonic endoscopic ultrasound in differentiating solid lesions of the pancreas: A single-center experience in Korea. Gut Liver. 7:599–604. 2013. View Article : Google Scholar : PubMed/NCBI
14	Park JS, Kim HK, Bang BW, Kim SG, Jeong S and Lee DH: Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses. World J Gastroenterol. 20:518–524. 2014. View Article : Google Scholar : PubMed/NCBI
15	Yamashita Y, Kato J, Ueda K, Nakamura Y, Kawaji Y, Abe H, Nuta J, Tamura T, Itonaga M, Yoshida T, et al: Contrast-enhanced endoscopic ultrasonography for pancreatic tumors. Biomed Res Int 2015. 4917822015.
16	Săftoiu A, Vilmann P, Dietrich CF, Iglesias-Garcia J, Hocke M, Seicean A, Ignee A, Hassan H, Streba CT, Ioncică AM, et al: Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc. 82:59–69. 2015. View Article : Google Scholar : PubMed/NCBI
17	Kamata K, Kitano M, Omoto S, Kadosaka K, Miyata T, Yamao K, Imai H, Sakamoto H, Harwani Y, Chikugo T, et al: Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy. 48:35–41. 2016.PubMed/NCBI
18	Iordache S, Costache MI, Popescu CF, Streba CT, Cazacu S and Săftoiu A: Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA. Med Ultrason. 18:18–24. 2016. View Article : Google Scholar : PubMed/NCBI
19	Uekitani T, Kaino S, Harima H, Suenaga S, Sen-Yo M and Sakaida I: Efficacy of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic ductal carcinoma. Saudi J Gastroenterol. 22:198–202. 2016. View Article : Google Scholar : PubMed/NCBI
20	Krishna SG and Lee JH: Endosonography in solid and cystic pancreatic tumors. J Interv Gastroenterol. 1:193–201. 2011. View Article : Google Scholar : PubMed/NCBI
21	Kim J: Endoscopic ultrasound-guided treatment of pancreatic cystic and solid masses. Clin Endosc. 48:308–311. 2015. View Article : Google Scholar : PubMed/NCBI
22	Eloubeidi MA, Jhala D, Chhieng DC, Chen VK, Eltoum I, Vickers S, Mel Wilcox C and Jhala N: Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer. 99:285–292. 2003. View Article : Google Scholar : PubMed/NCBI
23	Sakamoto H, Kitano M, Suetomi Y, Maekawa K, Takeyama Y and Kudo M: Utility of contrast-enhanced endoscopic ultrasonography for diagnosis of small pancreatic carcinomas. Ultrasound Med Biol. 34:525–532. 2008. View Article : Google Scholar : PubMed/NCBI
24	Dietrich CF, Ignee A and Frey H: Contrast-enhanced endoscopic ultrasound with low mechanical index: A new technique. Z Gastroenterol. 43:1219–1223. 2005. View Article : Google Scholar : PubMed/NCBI
25	Wu RI, Yoon WJ, Brugge WR, Mino-Kenudson M and Pitman MB: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) contributes to a triple-negative test in preoperative screening of pancreatic cysts. Cancer Cytopathol. 122:412–419. 2014. View Article : Google Scholar : PubMed/NCBI
26	Wang Y, Yan K, Fan Z, Sun L, Wu W and Yang W: Contrast- enhanced ultrasonography of pancreatic carcinoma: Correlation with pathologic findings. Ultrasound Med Biol. 42:891–898. 2016. View Article : Google Scholar : PubMed/NCBI