title: Probe-based confocal laser endomicroscopy for the diagnosis of undetermined biliary stenoses: A meta-analysis.
abstract: BACKGROUND
  Presently, both the accuracy and sensitivity for distinguishing biliary stenosis from benign to malignant are low. In recent articles, the probe-based confocal laser endomicroscopy (pCLE) showed a better sensitivity than traditional methods in diagnosing malignant biliary stenosis. Here, we conducted a meta-analysis to summarise the published literature.
  
  
  METHODS
  A systematic search for literature was conducted in the Medline, Embase and Cochrane Library databases published until November 2015. Further publications were found in the reference lists of the relevant articles. A quality assessment and data extraction were performed by two reviewers independently. A meta-analysis was performed to evaluate the diagnostic efficiency of a pCLE for discriminating benign and malignant biliary stenoses.
  
  
  RESULTS
  Eight studies involving 280 patients were included in the analysis. Significant heterogeneity in specificity was observed among the studies (Cochran's Q test=15.89, degrees of freedom [df]=7, P=0.0261 and I2=55.9%), while the heterogeneity in sensitivity was not obvious (Cochran's Q test=7.99, df=7, P=0.3334 and I2=12.4%). The area under the summary receiver operating characteristic (SROC) curve was 0.8968. The meta-regression and subgroup analysis indicated that the outlier was the source of heterogeneity. When analysed in the random-effects model, the pooled sensitivity, specificity, positive likelihood ratio (LR) and negative LR were 0.90 (0.84-0.94), 0.75 (0.66-0.83), 3.17 (2.18-4.61) and 0.17 (0.11-0.26), respectively. No significant publication bias was found in our research.
  
  
  CONCLUSIONS
  A pCLE is a valuable method for the differential diagnosis between malignant and benign biliary stenoses. However, a preferable diagnostic standard should be explored and improvements in specificity are required.
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, 197,Ruijin Er Road, Shanghai 200025, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Zhang
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Zhao-Zhen
authors.initials: ZZ
authors.lastname: Zhang
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: He
authors.affiliation: Department of Endoscopy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China. Electronic address: dryangxiujiang@126.com.
authors.forename: Xiu-Jiang
authors.initials: XJ
authors.lastname: Yang
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D016013:Likelihood Functions; D018613:Microscopy, Confocal / Q000379:methods*; D012680:Sensitivity and Specificity