title: Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis.
  
  
  METHODS
  Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing.
  
  
  RESULTS
  The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant.
  
  
  CONCLUSIONS
  CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.
authors.affiliation: Department of Ultrasound in West China Hospital, University of Sichuan, Chengdu, China E-mail : yulanpeng_scu@163.com.
authors.forename: Ya
authors.initials: Y
authors.lastname: Jin
authors.forename: Yu-Shuang
authors.initials: YS
authors.lastname: He
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: Zhang
authors.forename: Shyam Sundar
authors.initials: SS
authors.lastname: Parajuly
authors.forename: Shuang
authors.initials: S
authors.lastname: Chen
authors.forename: Hai-Na
authors.initials: HN
authors.lastname: Zhao
authors.forename: Yu-Lan
authors.initials: YL
authors.lastname: Peng
mesh_terms: D006801:Humans; D003287:Contrast Media / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000175:diagnosis; D012372:ROC Curve; D014018:Tissue Distribution; D014463:Ultrasonography / Q000706:statistics & numerical data
chemical_list: D003287:Contrast Media