A meta-analysis of contrast-enhanced ultrasound for small hepatocellular carcinoma diagnosis

To discuss the efficacy of contrast-enhanced ultrasound (CEUS) for diagnosis of small hepatocellular carcinoma (HCC) by pooling the open published data.

A comprehensive publication electronic search was performed by reviewers in the databases of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure. The open published studies about CEUS for small HCC diagnosis were collected. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (DOR) were pooled by stata 12.0 software.

A total of 16 studies were included in the present study. The sensitivity, specificity, +LR, and -LR were aggregated by random effects model because of significant heterogeneity (I2 >50.0%). However, DOR was pooled by fixed effects model without significant heterogeneity (I2 <50.0%). The aggregate sensitivity was 0.86 (95% confidence interval [CI]: 0.79-0.91); the aggregate specificity was 0.87 (95% CI: 0.75-0.94); the aggregate +LR and -LR were 7.06 (95% CI: 1.64-30.36) and 0.20 (95% CI: 1.64-30.36), respectively. The DOR was 33.71 (95% CI: 20.34-55.88); the area under the receiver operating characteristic was 0.93 (95% CI: 0.90-0.95). There was significant publication bias tested by funnel plot and line regression test (t = 2.29, P < 0.05).

With the present evidence, CEUS is useful for diagnosis of small HCC with relatively high sensitivity and specificity.