Original article
Clinical endoscopy
EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis

https://doi.org/10.1016/j.gie.2012.09.035Get rights and content

Background

The differential diagnosis of solid pancreatic masses has been a significant challenge up until now. EUS elastography is now used as a new technique to distinguish benign from malignant pancreatic masses. However, the sensitivity, specificity, and accuracy are still questionable.

Objective

To evaluate the accuracy of EUS elastography for diagnosis of solid pancreatic masses.

Design

Thirteen articles for EUS elastography diagnosing solid pancreatic masses were selected. The Mantel-Haenszel and DerSimonian Laird methods were used to analyze pooled results.

Setting

Patients: This study involved 1044 patients.

Intervention

EUS elastography.

Main Outcome Measurements

The pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and summary receiver operating characteristic (sROC) curve.

Results

The pooled sensitivity, specificity, and diagnostic odds ratio of EUS elastography distinguishing benign from malignant solid pancreatic masses were 0.95 (95% confidence interval [CI], 0.94-0.97), 0.67 (95% CI, 0.61-0.73), and 42.28 (95% CI, 26.90-66.46), respectively. The sROC area under the curve was 0.9046. The subgroup analysis based on excluding the outliers showed that the heterogeneity was eliminated, and the pooled sensitivity and specificity were 0.95 (95% CI, 0.93-0.97) and 0.7 (95% CI, 0.63-0.76), respectively. The sROC area under the curve was 0.8872.

Limitations

Varied diagnostic standards for EUS elastography were used in the enrolled studies.

Conclusion

EUS elastography is a reliable technique for the characterization of solid pancreatic masses and may be a useful complementary tool for EUS-guided FNA. However, a more accurate computer-aided diagnosis method for EUS elastography is in demand to reduce various biases and improve the accuracy of EUS elastography for diagnosis of solid pancreatic masses.

Section snippets

Study selection

We defined inclusion and exclusion criteria by discussion before the literature search. Studies that met the following inclusion criteria were selected: (1) the use of EUS elastography for diagnosis of solid pancreatic masses; (2) solid pancreatic mass was the only lesion or combining with other lesions but analyzed separately; (3) the use of a reference standard of EUS-FNA cytology, surgical histology or clinical follow-up of at least 6 months; (4) written in English; (5) providing enough data

Results

The original search with predefined search strategy yielded 124 studies, and we retrieved 13 articles eligible for final analysis. The detailed flow chart was shown in Figure 1. The characteristics of the included studies are shown in Table 1. There were 9 studies published as full texts and 4 studies published as abstracts. A total of 1044 patients were investigated in the analysis. Of the 13 articles, 6 studies used color pattern as a diagnostic standard,18, 20, 23, 24, 26, 27 3 studies used

Discussion

EUS that provides high-quality sonographic images has been considered as one of the most reliable and accurate techniques for the diagnosis and staging of pancreatic cancer since its development in the 1980s.34, 35 Regardless of the development in imaging quality and resolution, the differential diagnosis of solid pancreatic masses remains a challenge in clinical work.6 In this context, EUS-FNA that obtains cytologic samples is considered as a useful and accurate tool for diagnosis of solid

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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