Abstract
Background: Previous studies have shown inconsistent results in the differential diagnosis obtained from bilateral inferior petrosal sinus sampling (BIPSS) in adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature. Methods: This study searched PubMed, Embase, Web of Science, the Cochrane library, and the Wanfang database for published data on the differential diagnosis obtained using BIPSS in Cushing syndrome as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data. Results: This meta-analysis included a total of 23 studies with 1,617 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively. Conclusion: This meta-analysis indicated that BIPSS had a highly diagnostic value for ACTH originally in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as a routine method to identify ACTH sources. Keywords: Bilateral inferior petrosal sinus sampling, ACTH-dependent Cushing syndrome, Differential diagnosis , Diagnostic meta-analysis