A Systematic Review On Real-time Tissue Elastography And Acoustic Radiation Force Impulse Elastography Used To Differentiate Benign From Malignant Focal Liver Lesions

Objective:To study the value of Real-time tissue elastography(RTE) and Acoustic radiation force impulse elastography(ARFI) in the differential diagnosis of benign and malignant focal liver lesions(FLLs) by systematic review.Methods : The databases such as Embase,Pubmed,The Cochrane library,China national knowledge infrastructure(CNKI), Wanfang Data, VIP and other databases were electronically retrieved. The retrieval time was from the establishment date of each database to December 2015.Google and Baidu were also used for making the filtration in the meanwhile.The diagnostic studies published in English or Chinese about the RTE or ARFI for FLLs were strictly filtrated according to the inclusion and exclusion criteria. The quality of the included studies were evaluated using the QUADAS and the relevant data were extracted.Meta-DiSc software(Version 1.4) was used for heterogeneity study and statistical pooling.The pooled SEN,SPE, +LR,–LR,DOR and the corresponding 95%CI were calculated.The SROC curve was performed and the AUROC was calculated.Stata software(Version 14.0) was used to investigate the publication bias and perform the Deeks’ funnel plots.Results:A total of 21 RTE studies involving 2446 patients and 28 ARFI studies involving 2687 patients were included.The pooled SEN,SPE, +LR,–LR and DOR for RTE were 88%(95%CI 0.86~0.89),87%(95%CI 0.85~0.89),6.29(95%CI 4.85~8.14),0.14(95%CI 0.13~0.16) and 45.55(95%CI 36.56~56.76),respectively.The AUROC for RTE was 0.9348.The pooled SEN,SPE, +LR,–LR and DOR for ARFI were 85%(95%CI 0.83~0.87),80%(95%CI 0.78~0.82),4.18(95%CI 3.73 ~ 4.67),0.20(95 % CI 0.17 ~ 0.24) and 22.67(95 % CI 16.72 ~ 30.72),respectively.The AUROC for ARFI was 0.8955.Conclusion:Current evidence shows that both RTE and ARFI have a high value in the differential diagnosis of benign and malignant FLLs.In the future, additional large and high-quality clinical studies remain necessary to further verify or optimize this conclusion.