The efficiency of contrast-enhanced endoscopic ultrasound (EUS) combined with EUS elastography for pancreatic cancer diagnosis: a systematic review and meta-analysis.

purposeThis study aimed to evaluate the performance characteristics of endoscopic ultrasound (EUS) elastography combined with contrast-enhanced EUS (CE-EUS) for the diagnosis of pancreatic malignancy among solid pancreatic lesions (SPLs).

methodsA comprehensive literature search using MEDLINE, Embase, and the Cochrane Library was performed from January 1991 through December 2020. The pooled performance characteristics, including sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (OR), were calculated using Meta-DiSc 1.4.

resultsIn total, 430 patients with 282 pancreatic malignancies were included in the metaanalysis. The pooled sensitivity, specificity, LR+, LR-, and diagnostic OR were 84% (95% confidence interval [CI], 80% to 88%), 85% (95% CI, 78% to 90%), 5.31 (95% CI, 2.57 to 10.97), 0.15 (95% CI, 0.07 to 0.34), and 67.72 (95% CI, 12.84 to 357.26) for the combination of CE-EUS and EUS elastography, respectively. In these same studies, the corresponding performance characteristics for EUS elastography were 87% (95% CI, 82% to 90%), 56% (95% CI, 48% to 64%), 2.28 (95% CI, 1.43 to 3.63), 0.12 (95% CI, 0.03 to 0.42), and 22.60 (95% CI, 5.81 to 87.92), respectively. In these same studies, the respective performance characteristics for CE-EUS were 84% (95% CI, 80% to 88%), 78% (95% CI, 70% to 84%), 3.80 (95% CI, 1.92 to 7.53), 0.13 (95% CI, 0.04 to 0.41), and 31.29 (95% CI, 6.12 to 159.87).

conclusionCE-EUS and EUS elastography are reliable supplemental techniques for the characterization of SPLs and diagnosis of pancreatic malignancies. However, more studies assessing the combined utilization of both procedures are needed.