Elsevier

Pancreatology

Volume 12, Issue 5, September–October 2012, Pages 402-408
Pancreatology

Original article
Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: A meta-analysis

https://doi.org/10.1016/j.pan.2012.07.013Get rights and content

Abstract

Background/Aims

EUS elastography is a novel technique that can be used for distinguishing benign from malignant lymph nodes and focal pancreatic masses. However, the studies pertaining to EUS elastography for differential diagnosis of solid pancreatic masses have reported widely varied sensitivities and specificities. A meta-analysis of all relevant articles was performed to estimate the overall diagnostic accuracy of EUS elastography for differentiating benign and malignant solid pancreatic masses.

Methods

The literatures were identified by searching in PubMed and Embase databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve (SROC) also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity.

Results

13 studies including a total of 1042 patients with solid pancreatic masses were selected for meta-analysis. The pooled sensitivity and specificity of EUS elastography for differentiating benign and malignant solid pancreatic masses were 95% (95% confidence interval [CI], 93%–96%), 69% (95% CI, 63%–75%), respectively. The area under SROC (AUC) was 0.8695. Two significant variables were associated with heterogeneity: color pattern and blinding.

Conclusion

As a less invasive modality, EUS elastography is a promising method for differentiating benign and malignant solid pancreatic masses with a high sensitivity, and it can prove to be a valuable supplement to EUS-FNA.

Section snippets

Study selection

Inclusion criteria: (1) diagnostic clinical trials evaluating the accuracy of EUS elastography in differential diagnosis of benign and malignant solid pancreatic masses; (2) acceptable reference standards included EUS-FNA, surgical exploration, or a clinical follow-up period of at least 6 months; (3) the outcome data available to reconstruct a diagnostic 2 × 2 table (true positive, true negative, false positive, false negative).

Exclusion criteria: (1) complete data unavailable; (2) duplicated

Literature search and characteristics of the included studies

A total of 100 studies were initially identified by using the search strategy. 69 studies were excluded by screening the titles and abstracts. Of the 31 studies left, 13 published articles that met the inclusion and exclusion criteria were identified finally. The study selection process is shown in Fig. 1.

A total of 1042 patients were estimated in the meta-analysis, with sample size ranging from 24 to 258 patients (mean N = 80). The mean lesion size ranged from 24.7 mm to 39.2 mm. Three

Discussion

Pancreatic malignancy, mostly pancreatic carcinoma, is considered to have one of the worst prognoses among all the solid malignancies, with an overall 5-year survival rate of less than 5% [41], [42]. While some studies have shown that early stage pancreatic lesions have a significantly better prognosis with a 5-year survival rate of up to 25–30% [43], [44]. Therefore, early differential diagnosis of malignant tumor in pancreatic lesions is essential to improve the patient survival.

EUS is an

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    Qingshan Pei and Xiaoping Zou contributed equally to this article.

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