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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 8  |  Page : 274-276

A meta-analysis of contrast-enhanced ultrasound for small hepatocellular carcinoma diagnosis


Department of Ultrasound, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000, PR China

Date of Web Publication22-Feb-2017

Correspondence Address:
Hongwei Shi
Department of Ultrasound, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200756

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 > Abstract 

Objective: To discuss the efficacy of contrast-enhanced ultrasound (CEUS) for diagnosis of small hepatocellular carcinoma (HCC) by pooling the open published data.Methods: A comprehensive publication electronic search was performed by reviewers in the databases of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure. The open published studies about CEUS for small HCC diagnosis were collected. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (–LR), and diagnostic odds ratio (DOR) were pooled by stata 12.0 software.
Results: A total of 16 studies were included in the present study. The sensitivity, specificity, +LR, and –LR were aggregated by random effects model because of significant heterogeneity (I2 >50.0%). However, DOR was pooled by fixed effects model without significant heterogeneity (I2 <50.0%). The aggregate sensitivity was 0.86 (95% confidence interval [CI]: 0.79–0.91); the aggregate specificity was 0.87 (95% CI: 0.75–0.94); the aggregate +LR and –LR were 7.06 (95% CI: 1.64–30.36) and 0.20 (95% CI: 1.64–30.36), respectively. The DOR was 33.71 (95% CI: 20.34–55.88); the area under the receiver operating characteristic was 0.93 (95% CI: 0.90–0.95). There was significant publication bias tested by funnel plot and line regression test (t = 2.29, P < 0.05).
Conclusion: With the present evidence, CEUS is useful for diagnosis of small HCC with relatively high sensitivity and specificity.

Keywords: Contrast-enhanced ultrasound, hepatocellular carcinoma, meta-analysis


How to cite this article:
Deng H, Shi H, Lei J, Hu Y, Li G, Wang C. A meta-analysis of contrast-enhanced ultrasound for small hepatocellular carcinoma diagnosis. J Can Res Ther 2016;12:274-6

How to cite this URL:
Deng H, Shi H, Lei J, Hu Y, Li G, Wang C. A meta-analysis of contrast-enhanced ultrasound for small hepatocellular carcinoma diagnosis. J Can Res Ther [serial online] 2016 [cited 2017 Mar 26];12:274-6. Available from: http://www.cancerjournal.net/text.asp?2016/12/8/274/200756


 > Introduction Top


Hepatocellular carcinoma (HCC) is the fifth most diagnosed malignant carcinoma worldwide.[1] Moreover, with an increasing incidence, HCC has become the 3rd leading cause of cancer-related deaths worldwide, with over 500 000 deaths each year.[2] As we known, one of the important risk factors for HCC is cirrhosis, which was generally caused by hepatitis viral infection. In China, hepatitis viral infection was very common. It was reported that about 10% people were Hbs Ag positive. For patients with cirrhosis, early diagnosis of small HCC is most important for the prognosis. For the low cost, wide availability, and noninvasiveness, contrast-enhanced ultrasound (CEUS) had been widely used for the prevention, diagnosis, and surveillance of HCC. Several studies [3],[4] have discussed the efficacy of CEUS for diagnosis of small HCC. However, because of the cause of the small sample size, the conclusions of the previous study were not in agreement. To solve this problem, we performed this meta-analysis to further evaluate CEUS for small HCC diagnosis.


 > Methods Top


A comprehensive publication electronic search was performed by two reviewers in the databases of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure. The open published studies about CEUS for small HCC diagnosis were collected. The following terms were used for searching the databases: contrast-enhanced ultrasonography” or “contrast-enhanced ultrasound” or “CEUS” or “contrast-enhanced US” or “contrast enhanced Doppler ultrasonography,” and “small hepatic tumor” or “small hepatocellular carcinoma” or “small liver tumor” or “small hepatic cancer” or “small liver cancer. For the included study, the year of publication, first and corresponding author, number of true positive, false positive, false negative, and true negative were extracted from the original included publications. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (–LR), diagnostic odds ratio (DOR), and area under the curve of CEUS for small HCC diagnosis were aggregated by stata 12.0 software (http://www.stata.com).


 > Results Top


Information of included studies

In accordance with the inclusion and exclusion criteria, we finally included 16 studies in this meta-analysis. The publication year ranges from 2001 to 2010 with seven studies done in China mainland, 1 in Taiwan, 5 in Italy, 1 in Spain, 1 in Canada, and 1 in Japan. [Table 1] shows the main characteristics of the included 16 publications.
Table 1: Main characteristics of included publications

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Meta-analysis

The sensitivity, specificity, +LR, and –LR were aggregated by random effects model because of significant heterogeneity (I2 >50.0%). However, DOR was pooled by fixed effects model without significant heterogeneity (I2 <50.0%). The aggregate sensitivity was 0.86 (95% confidence interval [CI]: 0.79–0.91); the aggregate specificity was 0.87 (95% CI: 0.75–0.94); the aggregate +LR and –LR were 7.06 (95% CI: 1.64–30.36) and 0.20 (95% CI: 1.64–30.36), respectively. The DOR was 33.71 (95% CI: 20.34–55.88) [Table 2]; the area under the receiver operating characteristic (ROC) was 0.93 (95% CI: 0.90–0.95), [Figure 1].
Table 2: The aggregated diagnostic items

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Figure 1: The aggregate receiver operating characteristic curve

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Publication bias

There was significant publication bias tested by funnel plot [Figure 2] and line regression test (t = 2.29, P < 0.05).
Figure 2: The funnel plot for evaluation publication bias

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 > Discussion Top


In this meta-analysis, we included 16 previously published studies associated with CEUS for small HCC diagnosis. Of the included 16 publications, seven studies were done in China mainland, 1 in Taiwan, 5 in Italy, 1 in Spain, 1 in Canada, and 1 in Japan. The sample size ranged from 30 to 104, which was relatively small for diagnosis study. Hence, the results of separate individual study were unstable and can be affected by many confounding factors.[19] Therefore, we extracted the data from each study and pooled the diagnostic sensitivity, sensitivity, specificity, +LR, –LR, and DOR. The sensitivity, specificity, +LR, and –LR were aggregated by random effects model because of significant heterogeneity (I2 >50.0%). However, DOR was pooled by fixed effects model without significant heterogeneity (I2 <50.0%). The aggregate sensitivity was 0.86 (95% CI: 0.79–0.91); the aggregate specificity was 0.87 (95% CI: 0.75–0.94); the aggregate +LR and –LR were 7.06 (95% CI: 1.64–30.36) and 0.20 (95% CI: 1.64–30.36), respectively. The DOR was 33.71 (95% CI: 20.34–55.88) [Table 2]; the area under the ROC was 0.93 (95% CI: 0.90–0.95). These results indicated that CEUS was useful for diagnosis of small HCC.


 > Conclusion Top


CEUS had relative high sensitivity and specificity for small HCC diagnosis, which can be used for small HCC screening for patients with cirrhosis. However, in this study, we also found several limitations: (1) there was significant publication bias in this study, this means that many negative studies have not been published or included in this study;[20] (2) there was significant statistical heterogeneity for sensitivity, specificity, +LR, and –LR; (3) there was no quality assessment for each included study; and (4) moreover, only studies published in English or Chinese were searched in the databases and included in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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