Meta-analysis of contrast-enhanced ultrasonography for the detection of gallbladder carcinoma.

Aim: To systematically evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) for the detection of gallbladder carcinoma. Material and method: Relevant studies were identified searching PubMed, Embase, Elsevier, the CNKI (China National Knowledge Infrastructure) database and the Cochrane Trial Register searches until August 2015. Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic (ROC) curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in the diagnosis of gallbladder carcinoma. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. Results: From 89 citations, 16 were included in the meta-analysis with a total of 1673 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.92 (95% CI: 0.90, 0.94), the specificity was 0.91 (95% CI: 0.89, 0.93), the positive likelihood ratio was 10.01 (95% CI: 7.02, 14.29), the negative likelihood ratio was 0.10 (95% CI: 0.07, 0.14), and the diagnostic odds ratio was 123.02 (95% CI: 78.40, 193.03). The area under the ROC curve was 0.9689 (95% CI: 0.9376, 0.9879). Conclusions: CEUS is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of gallbladder carcinoma. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.