Meta-analysis of variable-temperature PCR technique performance for diagnosising Schistosoma japonicum infections in humans in endemic areas

Background As China is moving onto schistosomiasis elimination/eradication, diagnostic methods with both high sensitivity and specificity for Schistosoma japonicum infections in humans are urgently needed. Microscopic identification of eggs in stool is proven to have poor sensitivity in low endemic regions, and antibody tests are unable to distinguish between current and previous infections. Polymerase chain reaction (PCR) technologies for the detection of parasite DNA have been theoretically assumed to show high diagnostic sensitivity and specificity. However, the reported performance of PCR for detecting S. japonicum infection varied greatly among studies. Therefore, we performed a meta-analysis to evaluate the overall diagnostic performance of variable-temperature PCR technologies, based on stool or blood, for detecting S. japonicum infections in humans from endemic areas. Methods We searched literatures in eight electronic databases, published up to 20 January 2021. The heterogeneity and publication bias of included studies were assessed statistically. The risk of bias and applicability of each eligible study were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2). The bivariate mixed-effects model was applied to obtain the summary estimates of diagnostic performance. The hierarchical summary receiver operating characteristic (HSROC) curve was applied to visually display the results. Subgroup analyses and multivariate regression were performed to explore the source of heterogeneity. This research was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was registered prospectively in PROSPERO (CRD42021233165). Results A total of 2791 papers were retrieved. After assessing for duplications and eligilibity a total of thirteen publications were retained for inclusion. These included eligible data from 4268 participants across sixteen studies. High heterogeneity existed among studies, but no publication bias was found. The pooled analyses of PCR data from all included studies resulted in a sensitivity of 0.91 (95% CI: 0.83 to 0.96), specificity of 0.85 (95% CI: 0.65 to 0.94), positive likelihood ratio of 5.90 (95% CI: 2.40 to 14.60), negative likelihood ratio of 0.10 (95% CI: 0.05 to 0.20) and a diagnostics odds ratio of 58 (95% CI: 19 to 179). Case-control studies showed significantly better performances for PCR diagnostics than cross-sectional studies. This was further evidenced by multivariate analyses. The four types of PCR approaches identified (convention PCR, qPCR, Digital droplet PCR and nested PCR) differed significantly, with nested PCRs showing the best performance. Conclusions Variable-temperature PCR has a satisfactory performance for diagnosing S. japonicum infections in humans in endemic areas. More high quality studies on S. japonicum diagnostic techniques, especially in low endemic areas and for the detection of dual-sex and single-sex infections are required. These will likely need to optimise a nested PCR alongside a highly sensitive gene target. They will contribute to successfully monitoring endemic areas as they move towards the WHO 2030 targets, as well as ultimately helping areas to achieve these goals.

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Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.621389 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jianfeng Xu ◽

Fei Cai ◽

Changran Geng ◽

Zheng Wang ◽

Xiaobin Tang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Likelihood Ratio ◽

Subgroup Analysis ◽

Diagnostic Performance ◽

Meta Analysis ◽

Diagnostic Methods ◽

Cochrane Library ◽

Emission Computed Tomography ◽

Artery Disease

Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making.Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated.Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)].Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.

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Diagnostic test accuracy for detecting Schistosoma japonicum and S. mekongi in humans: A systematic review and meta-analysis

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009244 ◽

2021 ◽

Vol 15 (3) ◽

pp. e0009244

Author(s):

Md. Obaidur Rahman ◽

Miho Sassa ◽

Natasha Parvin ◽

Md. Rashedul Islam ◽

Aya Yajima ◽

...

Keyword(s):

Systematic Review ◽

Schistosoma Japonicum ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Diagnostic Methods ◽

Cochrane Library ◽

Stool Examination ◽

Enzyme Linked Immunosorbent Assay ◽

Detection Accuracy ◽

Test Accuracy

Background Most of national schistosomiasis elimination programmes in Asia are relying on stool examination, particularly Kato Katz stool examination technique for regular transmission monitoring. However, the Kato-Katz technique has shown low sensitivity for the detection of light-intensity infections, and therefore highly sensitive diagnostic tools are urgently required to monitor prevalence of infection in low transmission settings. The objective of this systematic review was to evaluate and synthesize the performance of diagnostic tests for detecting Schistosoma japonicum and S. mekongi infection in people living in endemic areas. Methodology/Principal findings We comprehensively searched these nine electronic databases and other resources until July 2019, with no language or publication limits: PubMed, EMBASE, MEDLINE, Web of Science, BIOSIS Citation Index, HTA, CINAHL PLUS, The Cochrane Library, and PsycINFO. We included original studies that assessed diagnostic performance using antibody, antigen, and molecular tests with stool examination test as a reference standard. Two reviewers independently extracted a standard set of data and assessed study quality. We estimated the pooled estimates of sensitivity and specificity for each index test. We used diagnostic odds ratio to determine the overall accuracy and hierarchical summary receiver operating characteristics (HSROC) curve to assess the index tests performance. Fifteen studies (S. japonicum [n = 13] and S. mekongi [n = 2]) testing 15,303 participants were included in the review. Five studies reported performance of enzyme-linked immunosorbent assay (ELISA), seven studies reported indirect hemagglutination assay (IHA), and four studies reported polymerase chain reaction (PCR) for detecting S. japonicum. The pooled sensitivity and specificity were 0.93 (95% CI: 0.84–0.98) and 0.40 (95% CI: 0.29–0.53) for ELISA, 0.97 (95% CI: 0.90–0.99) and 0.66 (95% CI: 0.58–0.73) for IHA, and 0.89 (95% CI: 0.71–0.96) and 0.49 (95% CI: 0.29–0.69) for PCR respectively. A global summary indicated the best performance for IHA, closely followed by ELISA. We were unable to perform meta-analysis for S. mekongi due to insufficient number of studies. Conclusions/Significance IHA showed the highest detection accuracy for S. japonicum. Further studies are needed to determine the suitable diagnostic methods to verify the absence of transmission of S. mekongi and also to compare detection accuracy against more sensitive reference standards such as PCR.

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Diagnostic Performance of Noninvasive Imaging Modalities for Localization of Insulinoma: A Meta-Analysis

10.21203/rs.3.rs-724404/v1 ◽

2021 ◽

Author(s):

Yi Yang ◽

Jian Shi ◽

Jianbing Zhu

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Ct Imaging ◽

Superior Performance ◽

Cochrane Library ◽

Pet Ct ◽

Ct And Mri

Abstract BackgroundInsulinomas is the most common functional neuroendocrine tumor found only in the pancreas. The early detection of insulinoma is of importance. Studies comparing the performance of noninvasive modalities were limited by sample size and heterogeneity between studies. The aim of this meta-analysis was to evaluate the diagnostic performance of PET/CT, SPECT/CT, CT and MRI for the localization of insulinoma, and to provide evidence for clinical practice.MethodsPubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to May 31, 2021. Pooled sensitivity, specificity, positive Likelihood Ratio (+LR) and negative Likelihood Ratio (-LR), diagnostic odds ratio (DOR), and concordance rate were calculated.ResultsA total of 19 studies including 708 patients of insulinoma reached the inclusion criteria. PET/CT imaging demonstrated a pooled sensitivity of 0.79 (95% CI: 0.54–0.92) and a pooled specificity of 0.84 (95% CI: 0.20–0.99). The pooled sensitivity and specificity of SPECT/CT were 0.77 (95% CI: 0.46–0.93) and 0.45 (95% CI: 0.22–0.70). CT showed an overall sensitivity of 0.54 (95% CI:0.35–0.72) and specificity of 0.75 (95% CI: 0.54–0.88). The pooled sensitivity and specificity for MRI were 0.54 (95% CI: 0.31–0.75) and 0.65 (95% CI: 0.39–0.84), respectively. The concordance rates of PET, SPECT, CT, and MRI were 78% (95% CI: 66%-90%), 74% (95% CI: 52%-97%), 56% (95% CI: 41%-72%), and 53% (95% CI: 33%-73%), respectively.ConclusionResults of this study indicate that PET/CT demonstrated superior performance than SPECT/CT, CT and MRI for the localization of insulinoma. GLP-1R based PET/CT manifested better diagnostic performance in comparison with SSTR based PET/CT imaging modality.

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

Medical Ultrasonography ◽

10.11152/mu.2013.2066.183.wei ◽

2016 ◽

Vol 18 (3) ◽

pp. 281 ◽

Cited By ~ 13

Author(s):

Wei Wang ◽

Yang Fei ◽

Feng Wang

Keyword(s):

Publication Bias ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Gallbladder Carcinoma ◽

Roc Curve ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Contrast Enhanced ◽

Contrast Enhanced Ultrasonography

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.

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Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Visceral Medicine ◽

10.1159/000514196 ◽

2021 ◽

pp. 1-11

Author(s):

Bing-Jie Xiang ◽

Min Jiang ◽

Ming-Jun Sun ◽

Cong Dai

Keyword(s):

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Inflammatory Bowel

Objective: Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. Methods: We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Results: Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. Conclusion: Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

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Magnetic Resonance Imaging for Surveillance of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11091665 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1665

Author(s):

Dong Hwan Kim ◽

Sang Hyun Choi ◽

Ju Hyun Shim ◽

So Yeon Kim ◽

Seung Soo Lee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Magnetic Resonance ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Early Stage ◽

Meta Analysis ◽

Random Effects Model ◽

Resonance Imaging ◽

Meta Regression

Our meta-analysis aimed to evaluate the diagnostic performance of surveillance magnetic resonance imaging (sMRI) for detecting hepatocellular carcinoma (HCC), and to compare the diagnostic performance of sMRI between different protocols. Original articles about the diagnostic accuracy of sMRI for detecting HCC were found in major databases. The meta-analytic pooled sensitivity and specificity of sMRI for detecting HCC were determined using a bivariate random effects model. The pooled sensitivity and specificity of full MRI and abbreviated MRI protocols were compared using bivariate meta-regression. In the total seven included studies (1830 patients), the pooled sensitivity of sMRI for any-stage HCC and very early-stage HCC were 85% (95% confidence interval, 79–90%; I2 = 0%) and 77% (66–85%; I2 = 32%), respectively. The pooled specificity for any-stage HCC and very early-stage HCC were 94% (90–97%; I2 = 94%) and 94% (88–97%; I2 = 96%), respectively. The pooled sensitivity and specificity of abbreviated MRI protocols were 87% (80–94%) and 94% (90–98%), values that were comparable with those of full MRI protocols (84% [76–91%] and 94% [89–99%]; p = 0.83). In conclusion, sMRI had good sensitivity for detecting HCC, particularly very early-stage HCC. Abbreviated MRI protocols for HCC surveillance had comparable diagnostic performance to full MRI protocols.

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Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

Journal of Interventional Cardiology ◽

10.1155/2020/7352150 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ruitao Zhang ◽

Jianwei Zhang ◽

Lijun Guo

Keyword(s):

Sensitivity And Specificity ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Diagnostic Performance ◽

Meta Analysis ◽

Flow Ratio ◽

Fractional Flow ◽

Flow Reserve ◽

Quantitative Flow Ratio ◽

Quantitative Flow

Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.

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Diagnostic Accuracy of Epithelial Membrane Antigen for Malignant Effusions: A Meta-Analysis

The International Journal of Biological Markers ◽

10.5301/jbm.5000181 ◽

2016 ◽

Vol 31 (1) ◽

pp. 11-16 ◽

Cited By ~ 1

Author(s):

Wentao Lin ◽

Xiaoxue Liu ◽

Ying Cen

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Epithelial Membrane Antigen ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Potential ◽

Malignant Effusions

Background and Objectives Body cavity fluid examination sometimes presents a diagnostic challenge in cytology practice. This meta-analysis was undertaken to comprehensively assess the diagnostic potential of epithelial membrane antigen (EMA) in malignant effusions. Materials and Methods All relevant original articles about EMA in the diagnosis of malignant effusions published up to July 1, 2014 were retrieved. The overall sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic (SROC) curve were pooled to evaluate the diagnostic value of EMA for malignant effusions using the Meta-Disc 1.4 and STATA 12.0 statistical software. Results Eleven studies met the inclusion criteria for the meta-analysis and the summary estimates for EMA in the diagnosis of malignant effusions were as follows: sensitivity 0.9 (95% CI 0.83-0.87), specificity 0.87 (95% CI 0.96-0.99), positive likelihood ratio 5.8 (95% CI 15.59-36.37), negative likelihood ratio 0.15 (95% CI 0.07-0.20) and diagnostic odds ratio 52.63 (95% CI 20.91-132.49). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.88; the area under the curve was 0.94. Conclusion The present meta-analysis indicated that EMA may be a useful diagnostic tool with good sensitivity and specificity for differentiating malignant effusions from benign effusions.

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Diagnostic performance of ultrasound for rotator cuff tears: a systematic review and meta-analysis

Medical Ultrasonography ◽

10.11152/mu-2352 ◽

2020 ◽

Vol 22 (2) ◽

pp. 197 ◽

Cited By ~ 2

Author(s):

Weiyu Liang ◽

Huaiyu Wu ◽

Fajin Dong ◽

Hongtian Tian ◽

Jinfeng Xu

Keyword(s):

Rotator Cuff ◽

Likelihood Ratio ◽

Diagnostic Performance ◽

High Efficiency ◽

Meta Analysis ◽

High Sensitivity ◽

Diagnostic Odds Ratio ◽

Rotator Cuff Tears ◽

Cochrane Library ◽

Summary Receiver Operating Characteristic

Aim: Rotator cuff (RC) tears are considered to be the main reason for shoulder pain. Although ultrasound is a useful method to detect it, its effectiveness when diagnosing RC tears has been a heated discussion. Therefore, we aimed at evaluating RC tears’ ultrasound accuracy by conducting a systemically review and pooled comprehensive analysis.Materials and methods: Relevant articles up to May 2018 were searched from the Cochrane Library, Embase, and Pubmed databases. Either arthroscopy or magnetic resonance imaging (MRI) was considered as a reference standard. The results were estimated by pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled-diagnostic odds ratio (P-DOR), pooled-likelihood ratio+ (PLR+), pooled-likelihood ratio- (P-LR-), and the area under the summary receiver operating characteristic (SROC).Result: We selected seven prospective studies in accordance with the inclusion criteria that covered 554 rotator cuff tears in 868 patients. The P-SEN, P-SPE, P-LR+, P-LR-, P-DOR, area under the SROC curve of diagnostic performance of ultrasound for RC and post-test probability were 95% (95% CI: 88 – 98), 72% (95% CI: 61 – 81), 3.41 (95% CI: 2.40 – 4.84), 0.08 (95% CI: 0.03 – 0.16), 45.31 (95% CI: 21.04 – 97.59), 89% (95% CI: 0.86 – 0.91), and 46% and 2%, respectively.Conclusion: Our metaanalysis demonstrates that ultrasound has a high efficiency for RC tears’ diagnosis. It can be a promising method in patients with suspected RC tears because of its high sensitivity, specificity and diagnostic accuracy.

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Diagnostic utility of endoscopic ultrasonography-elastography in the evaluation of solid pancreatic masses: a meta-analysis and systematic review

Medical Ultrasonography ◽

10.11152/mu-987 ◽

2017 ◽

Vol 19 (2) ◽

pp. 150 ◽

Cited By ~ 7

Author(s):

Yi Lu ◽

Lu Chen ◽

Chujun Li ◽

Honglei Chen ◽

Jinhua Chen

Keyword(s):

Sensitivity And Specificity ◽

Endoscopic Ultrasonography ◽

Meta Analysis ◽

Strain Ratio ◽

Diagnostic Odds Ratio ◽

Needle Aspiration ◽

Diagnostic Methods ◽

Pancreatic Masses ◽

Comprehensive Comparison ◽

Sensitivity Specificity

Aim: The accuracy for endoscopic ultrasonography-elastography (EUS-EG) in the evaluation of solid pancreatic masses varies greatly and the pooled results have not been updated since 2013. Also, there still lack a comprehensive comparison among EUS-EG, contrast-enhanced EUS (CE-EUS), and EUS-guided fine needle aspiration (EUS-FNA).Material and methods: A thorough search was made for diagnostic trials investigating the role of EUS-EG in solid pancreatic masses. Meta-Disc was used to calculate the pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operator characteristics. Results: Finally, 17 studies (1537 patients, 1544 lesions) were selected. The pooled sensitivity and specificity for qualitative methods were 0.97 (95%CI, 0.95-0.99) and 0.67 (95%CI, 0.59-0.74), respectively; the pooled sensitivity and specificity for strain histograms were 0.97 (95%CI, 0.95-0.98) and 0.67(95%CI, 0.61-0.73), respectively; the pooled sensitivity and specificity for strain ratio were 0.98 (95%CI, 0.96-0.99) and 0.62 (95%CI, 0.56-0.68), respectively; the pooled sensitivity and specificity for CE-EUS were 0.90 (95%CI, 0.83-0.95) and 0.76 (95%CI, 0.67-0.84), respectively; the pooled sensitivity and specificity for EUS-FNA were 0.84 (95%CI, 0.77-0.90) and 0.96(95%CI, 0.88-1.00), respectively. Conclusion: EUS-EG is reliable for distinguishing solid pancreatic masses; the sensitivity and specificity for different diagnostic methods were very close. Both EUS-EG and CE-EUS can be valuable complementary supplements for EUS-FNA.

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