title: Diagnostic performance of contrast enhanced ultrasound in patients with prostate cancer: a meta-analysis.
abstract: OBJECTIVE
  We aimed to do a meta-analysis of the existing literature to assess the accuracy of prostate cancer (PCa) studies that use contrast-enhanced ultrasound (CEUS) as a diagnostic tool.
  
  
  METHODS
  The MEDLINE, EMBASE, and Cochrane Library databases were searched for relevant original articles published up to August 2012. Characteristics of Included studies were recorded. Methodological quality was assessed by using the quality assessment of diagnostic studies tool. Pooled weighted estimates of diagnostic odds ratio (DOR), sensitivity, specificity, and positive and negative likelihood ratio (LR) were calculated. A summary receiver operator characteristic (SROC) curve was constructed to calculate the area under the curve (AUC). Publication bias analysis was also performed.
  
  
  RESULTS
  Sixteen studies (2624 patients) were included in the meta-analysis. Various contrast agents and imaging modes were applied. The independent random-effects summary showed a variation in diagnostic values. The summary estimates of sensitivity, specificity, and DOR were 0.70, 0.74, and 9.09, respectively. The weighted positive and negative LR were 2.81 and 0.35, with statistically significant between-study heterogeneity (P < .001). Sensitivity was better in positive patient studies than positive biopsy cores ones (0.78 vs. 0.64). SROC plot displayed value for AUC (0.82). Begg's test (P = .822) and Egger's test (P = .198) did not show evidence of publication bias.
  
  
  CONCLUSIONS
  CEUS is a promising tool in the detection of PCa, but it cannot completely replace systematic biopsy under the present circumstances. It is necessary to standardize imaging techniques, contrast agents and diagnostic criteria. Large samples, multi-center studies and high-quality prospective trials are necessary to assess its clinical value.
authors.affiliation: Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, P. R. China. liymimeng@yahoo.com.cn
authors.forename: Yanmi
authors.initials: Y
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.forename: Xiang
authors.initials: X
authors.lastname: Fei
authors.forename: Yi
authors.initials: Y
authors.lastname: Gao
mesh_terms: D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015995:Prevalence; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018570:Risk Assessment; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media