title: Contrast-enhanced ultrasound for differential diagnosis of malignant and benign ovarian tumors: systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the performance of contrast-enhanced ultrasound (CE-US) in the differential diagnosis of malignant and benign ovarian tumors.
  
  
  METHODS
  We conducted a comprehensive literature search of PubMed and EMBASE to identify published articles evaluating the diagnostic potential of CE-US for the differentiation of benign and malignant ovarian tumors. Inclusion criteria were: (1) the study assessed the accuracy (or sensitivity and specificity) of CE-US for diagnosis of benign and malignant ovarian tumors; (2) it used surgery and histopathology as the reference standard for distinguishing between benign and malignant tumors; (3) it included data allowing construction of a 2×2 contingency table for true- and false-positives and negatives. We present summary sensitivity, specificity, diagnostic odds ratio (OR) and areas under the summary receiver-operating characteristics curves (AUCs).
  
  
  RESULTS
  Preliminary screening identified 103 papers, of which 11 fulfilled our predefined inclusion criteria and underwent final analysis. The pooled sensitivity and specificity of CE-US for diagnosis of benign and malignant ovarian tumors were 93% (95% CI, 89-96%) and 95% (95% CI, 92-96%), respectively. The pooled diagnostic OR was 171.2 (95% CI, 65.9-444.6) and the AUC was 0.98. I(2) values of sensitivity, specificity and diagnostic OR were 38.3%, 31.7% and 48.4%, respectively, all indicating moderate heterogeneity.
  
  
  CONCLUSIONS
  The evidence from available studies suggests CE-US is useful for discriminating between benign and malignant ovarian tumors; however, further studies are needed to examine whether CE-US has improved diagnostic test accuracy compared with that of standard two-dimensional Doppler sonography.
authors: Cancer Center, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.|Department of Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: X
authors: X
authors: Ma
authors: Cancer Center, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: Y
authors: Y
authors: Zhao
authors: Department of Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: B
authors: B
authors: Zhang
authors: Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: W
authors: W
authors: Ling
authors: Department of Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: H
authors: H
authors: Zhuo
authors: Cancer Center, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: H
authors: H
authors: Jia
authors: Department of Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
authors: P
authors: P
authors: Li
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D011230:Precancerous Conditions / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: adnexal nodules; contrast-enhanced ultrasound; diagnosis; ovarian cancer