Meta-Analysis
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World J Gastroenterol. Jun 21, 2013; 19(23): 3678-3684
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3678
Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: A systematic review and meta analysis
Srinivas R Puli, Nikhil Kalva, Matthew L Bechtold, Smitha R Pamulaparthy, Micheal D Cashman, Norman C Estes, Richard H Pearl, Fritz-Henry Volmar, Sonu Dillon, Michael F Shekleton, David Forcione
Srinivas R Puli, Smitha R Pamulaparthy, Micheal D Cashman, Fritz-Henry Volmar, Sonu Dillon, Michael F Shekleton, Division of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
Nikhil Kalva, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
Matthew L Bechtold, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MS 65212, United States
Norman C Estes, Richard H Pearl, Department of Surgery, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
David Forcione, Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: Puli SR, Pamulaparthy SR, Kalva N, Forcione D and Bechtold ML designed research; Puli SR, Bechtold ML, Kalva N and Pamulaparthy SR performed research; Cashman MD, Estes NC, Pearl RH, Volmar FH, Dillon S, Shekleton MF contributed with analytic tools; Puli SR and Forcione D analyzed data; Puli SR, Pamulaparthy SR and Kalva N wrote the paper.
Correspondence to: Srinivas R Puli, MD, Division of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, 100 NE Randolph Ave, Peoria, IL 61637, United States. srinivaspuli@yahoo.com
Telephone: +1-309-6249400 Fax: +1-309-6242291
Received: March 2, 2013
Revised: April 6, 2013
Accepted: April 13, 2013
Published online: June 21, 2013
Processing time: 110 Days and 5.6 Hours
Abstract

AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.

METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model).

RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall’s tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10.

CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.

Keywords: Endoscopic ultrasound; Ultrasound; Endosonography; Pancreatic mass; Neuroendocrine tumors; Sensitivity; Specificity; Positive predictive value; Negative predictive value

Core tip: The published data on the diagnostic accuracy of endoscopic ultrasound (EUS) for detection of pancreatic neuroendocrine tumors is varied. We conducted a comprehensive review of the published literature to assess the diagnostic accuracy of EUS in this setting. Our systematic review and meta-analysis has demonstrated an excellent sensitivity and specificity of EUS in this setting compared to previously published literature of other imaging modalities such as transabdominal ultrasound, computed tomography, and magnetic resonance imaging.