Contrast-enhanced EUS for the characterization of mural nodules within pancreatic cystic neoplasms: systematic review and meta-analysis

Background and aims

Pancreatic cystic neoplasms (PCNs) carry a not-negligible malignancy risk. Along with main duct dilation, presence of enhanced mural nodules represents a significant risk factor for malignancy. Several articles assessed the role of contrast-enhanced endoscopic ultrasound (CE-EUS) for the identification of malignant features in mural nodules. We evaluate the pooled diagnostic performance of CE-EUS for the identification of high-grade dysplasia or invasive carcinoma among mural nodules in PCNs.

Methods

A systematic review (Medline, PubMed, EMBASE) and meta-analysis were conducted. Subgroup analysis was used to assess the usefulness of a dedicated contrast-harmonic (CH-EUS). Primary outcome was pooled sensitivity for identification of high-grade dysplasia or invasive carcinoma.

Results

Ten studies (532 patients) were included. Pooled sensitivity of CE-EUS was 88.2% (95% CI, 82.7% – 92.5%), specificity 79.1% (95% CI, 74.5% - 83.3%) and diagnostic accuracy was 89.6% (95% CI, 83.4% - 95.8%). Eight studies (320 patients) were conducted using CH-EUS: pooled sensitivity increased to 97.0% (95% CI, 92.5% - 99.2%), specificity 90.4% (95% CI, 85.2% - 94.2%), with a diagnostic accuracy 95.6% (95% CI, 92.6% - 98.7%).

Conclusion

This study provided robust evidence on CE-EUS value for the characterization of mural nodules within PCNs. A dedicated contrast-harmonic mode, namely CH-EUS, provides an increased diagnostic yield in the identification and characterization of malignant mural nodules.

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