Contrast-enhanced harmonic endoscopic ultrasonography for the differential diagnosis of pancreatic masses: A systematic review and meta-analysis.

Understanding the difference between malignant and benign pancreatic masses is critical in terms of diagnosis, although this is difficult to determine in clinical practice. The contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) technique was introduced in 2010, although, to the best of the authors' knowledge, there has been no systematic review or meta-analysis to date evaluating its diagnostic performance for the differentiation of pancreatic masses. The aim of the present study was to systematically evaluate the diagnostic performance of CH-EUS for the differentiation of pancreatic masses. Search key words and inclusion and exclusion criteria were initially presented. Two independent authors read and extracted the relevant information from the included studies. Disagreements were resolved through discussion with another two experienced authors. Metadisc and Stata software were used for the meta-analysis and the evaluation of bias. A total of 16 studies comprising 1,325 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of CH-EUS were used to distinguish between malignant and benign tumors, and the values obtained were 93% [95% confidence interval (CI): 91-94%], 84% (95% CI: 80-87%), 5.58 (95% CI: 3.90-7.97), 0.09 (95% CI: 0.07-0.11) and 72.56 (95% CI: 48.93-107.60), respectively. The area under the summary receiver operating characteristic curve was determined to be 0.96. No publication bias was identified in this meta-analysis. Taken together, these results confirm that CH-EUS has a high accuracy rate for distinguishing between benign and malignant pancreatic space-occupying lesions, and it may therefore be used as an effective diagnostic tool for pancreatic masses.