Contrast-Enhanced Ultrasound for differential diagnosis of pancreatic mass lesions: a meta-analysis.

Abstract

Aim: To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) as a method for diagnosing pancreatic lesions with regard to the ductal pancreatic carcinoma and the differentiation of neoplastic from non-neoplastic lesions. Material and methods: Relevant studies published by September 6, 2015 were retrieved from PubMed, Embase, and Cochrane Central Trials databases. The articles included were mainly based on the following criteria: use of CEUS as the diagnostic tool, and the use of histology as the reference method. Two independent reviewers inspected all these papers to confirm the matching of the inclusion criteria. One reviewer with methodological expertise extracted the data from the included studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. Results: Eighteen studies out of 734 articles initially identified met the inclusion criteria. The primary study objective with respect to ductal adenocarcinoma was verified in 15 studies. The pooled estimate of CEUS sensitivity for the differential diagnosis of duct adenocarcinomas was 0.90 (95 % CI, 0.89-0.92), and the specificity was 0.88 (0.84-0.90). The pooled estimate for DOR was 56.38 (29.91-106.33). The area under the curve under the summary receiver operating characteristic (SROC) was 0.95. 12 out of 18 studies examined CEUS sensitivity and the average specificity with regard to the secondary study objective, distinguishing between neoplastic lesions and non-neoplastic lesions, were 0.95 (0.94-0.96) and 0.83 (0.77-0.87). The pooled estimate for DOR was 73. 25(45.31-118.43). The area under the SROC curve was 0.96. Conclusions: CEUS is a promising, reliable modality for the differential diagnosis of pancreatic adenocarcinoma in patients with pancreatic mass lesions. The presence of a hypoenhanced lesion was a sensitive predictor of pancreatic adenocarcinomas. It seems to be a useful tool in clinical practice.

UTMD-Promoted Co-Delivery of Gemcitabine and miR-21 Inhibitor by Dendrimer-Entrapped Gold Nanoparticles for Pancreatic Cancer Therapy

“…In addition, the subcutaneous pancreatic tumor vascularity after treatment was also observed by means of CEUS imaging to assess the therapeutic effect. CEUS imaging is a promising, reliable modality that can reveal tumor vascular flow and could be potentially useful to evaluate treatment effect after chemoradiotherapy 35 , 36 , 57 . CEUS images (Fig.…”

“…PaCa is well known to be a hypovascular tumour with less perfusion than the tissue surrounding it 35 , 36 . In order to enhance drug delivery, it is ideal to enlarge the permeability of vessels and the tumor cells.…”

Intraoperative Characterization of Pancreatic Tumors Using Contrast‐Enhanced Ultrasound and Shear Wave Elastography for Optimization of Surgical Strategies

“…2,17 Reproducible malignancy criteria in pancreatic IoCEUS were hypoenhancement during all contrast phases and irregular vascularization of septa in macrocystic lesions or small FPLs (<15 mm), which are consistent with findings of other authors. 2,17,19,20,[33][34][35] Although IoCEUS proved to be more sensitive in detection of malignant FPLs compared to IoSWE in this study, it showed difficulties in differentiating cystic FPLs, eg, IPMN lesions and cystadenoma, as well as chronic pancreatitis, from malignant FPLs. These limitations of CEUS have been reported by other authors before, 33,35 although findings of a few groups even suggested high diagnostic accuracy of CEUS in exactly such cases.…”

“…Dynamic visualization of FPLs' microvascularization can be performed well with CEUS. 2,[19][20][21] In percutaneous applications, CEUS is currently recommended for characterization of adenocarcinoma and solid and cystic lesions as well as for differentiation of pseudocysts and cystic tumors. 2 Furthermore, CEUS helps in defining margins of FPLs and enables visualization of the extent of tumor infiltration into the surrounding mesentericosplenic vessels.…”

“…Another important feature that helps distinguish malignant from benign FPLs is their microvascularization. Dynamic visualization of FPLs' microvascularization can be performed well with CEUS 2,19–21 . In percutaneous applications, CEUS is currently recommended for characterization of adenocarcinoma and solid and cystic lesions as well as for differentiation of pseudocysts and cystic tumors 2 .…”