Diagnostic Value of Qualitative and Quantitative Endoscopic Ultrasound Elastography for the Evaluation of Lymph Nodes: A Meta-analysis.

Abstract

Background and aims: The differential diagnosis of benign and malignant deep lymph nodes (LNs) has been a significant challenge up until now. Endoscopic ultrasound (EUS) elastography is a real-time imaging technique evaluated in several studies with diverse results. A meta-analysis was performed to assess the performance of EUS elastography for the differentiation of benign and malignant deep LNs.

Methods: All the eligible studies were searched by PubMed, Medline, Embase, and the Cochrane Library. A meta-analysis was performed to obtain pooled sensitivity, specificity, positive and negative likelihood ratio (LR). The diagnostic odds ratio (DOR) and area under the curve (AUC) were used to examine the accuracy of qualitative and quantitative EUS elastography.

Results: A total of eleven studies including 599 patients and 943 LNs were analyzed. In studies using the qualitative color pattern as the diagnostic standard, the pooled sensitivity, specificity, positive and negative LR were 0.82 [95% confidence interval (CI): 0.77-0.86)], 0.92 (95%CI: 0.89-0.94), 7.83 (95%CI: 3.58-17.09) and 0.22 (95%CI: 0.14-0.34), respectively. In studies using the quantitative value as the diagnostic standard, the pooled sensitivity, specificity, positive and negative LR were 0.80 (95%CI: 0.74-0.86) and 0.87 (95%CI: 0.82-0.92), 5.63 (95%CI: 3.46-9.17) and 0.23 (95%CI: 0.12-0.44), respectively. The summary DOR and the AUC were 48.73 (95%CI: 21.83-108.80) and 0.933 (Q*=0.869) for qualitative EUS elastography, 33.35 (95% CI: 12.81-86.87) and 0.923 (Q*=0.857) for quantitative EUS elastography.

Conclusions: Our meta-analysis shows that both qualitative and quantitative EUS elastography have high accuracy in the detection of malignant deep LNs, which could be used as a valuable complementary method to EUS-FNA for the differentiation of deep LNs in the future.