The Meta-analysis Of The Value Of CEUS,VTIQ And SMI In The Diagnosis Of Benign And Malignant Superficial Lymph Nodes

Objective:To summarize the literature related to the diagnosis of benign and malignant superficial lymph nodes by contrast enhanced ultrasonography（CEUS）,virtual touch tissue image and quantification（VTIQ）,and superb microvascular imaging（SMI）.Meta-analysis was conducted to evaluate the value of CEUS,VTIQ and SMI in the diagnosis of benign and malignant superficial lymph nodes.Method:The title or key words,including contrast enhanced ultrasonography,CEUS,virtual touch tissue imaging and quantification,VTIQ,superb mircovascular imaging,SMI,and lymph nodes,were used to search Chinese databases（China National Knowledge Infrastructure [CNKI],China biomedical literature database [Sinomed],Wanfang database and VIP database）.Combination of Me SH and Entry Terms were used to retrieve English databases（Pub Med,Web of science and the Cochrane library）.The limit of search time was from January 1,2015 to December 31,2021.Included literatures should meet the following criteria:（1）The superficial lymph nodes,including neck,axilla,groin,popliteal fossa,etc.,were involved in the study.（2）The original data including the number of true positive,false positive,false negative,and true negative for the differentiation of benign and malignant lymph nodes could be obtained directly or indirectly from each literature.（3）The number of lymph nodes was more than 30;（4）Pathological results can be obtained by surgery or puncture;（5）The studies included in the literature were all related to human;（6）Chinese or English literature.The included literatures were analyzed step by step in strict accordance with the steps of diagnostic meta-analysis and combined with relevant software.Result:A total of 27 studies related to CEUS,11 studies related to VTIQ and 7 studies related to SMI were included.The relevant meta-analysis results of CEUS,VTIQ and SMI are listed respectively as follows,combined sensitivity: 0.86（95% CI: 0.85-0.88）,0.88（95% CI: 0.85-0.91）and 0.89（95% CI: 0.84-0.92）;combined specificity: 0.88（95%CI: 0.87-0.89）,0.84（95% CI: 0.80-0.87）and 0.76（95% CI: 0.71-0.81）;positive likelihood ratio: 6.16（95% CI: 4.51-8.42）,5.38（95% CI: 4.40-6.58）and 5.14（95%CI: 2.35-11.24）;Negative likelihood ratio: 0.16（95% CI: 0.11-0.24）,0.14（95% CI:0.12-0.18）and 0.15（95% CI: 0.07-0.34）;Diagnostic odds ratio: 42.74（95% CI: 25.48-71.68）,40.70（95% CI: 28.51-58.11）and 37.96（95% CI:10.37-138.96）;AUC: 0.9316（SE: 0.0113）,0.9206（SE: 0.0150）and0.9257（SE: 0.0391）.Q*: 0.8671（SE: 0.0137）,0.8742（SE: 0.0110）and 0.8600（SE: 0.0460）.Z test was used to compare the SROCAUC between CEUS and SMI,Z（CEUS vs.SMI）= 0.15,P>0.05.No significant difference between CEUS and SMI was found in the diagnosis of benign and malignant superficial lymph node.The subgroup analysis without lymphoma and/or tuberculous lymph nodes showed that all indicators were significantly improved,suggesting that lymphoma and tuberculous lymph nodes are important sources of heterogeneity in CEUS and VTIQ.11 studies related to the diagnosis of axillary sentinel lymph nodes in early breast cancer by subcutaneous CEUS of areola showed a high AUC of 0.9406（SE: 0.0157）and Q* 0.8782（SE: 0.0199）.Seven studies of VTIQ to judge whether lymph node metastasis were analyzed.The AUC was 0.9472（SE:0.0098）and Q * was 0.8868（SE :0.00129）.Conclusion:1.The AUC of CEUS,VTIQ and SMI were all greater than 90%,suggesting high diagnostic value,which provides a richer imaging diagnostic basis for the judgment of the nature of superficial lymph nodes.2.There was no significant difference between CEUS and SMI in the judgment of benign and malignant superficial lymph nodes（P>0.05）.3.Lymphoma and tuberculous lymph nodes were important sources of heterogeneity in meta-analysis.4.For early breast cancer patients with axillary lymph node negative palpation,subcutaneous CEUS via areola could not only locate axillary sentinel lymph nodes,but also has high qualitative diagnostic value.5.VTIQ has the diagnostic value of judging whether lymph nodes have metastasis.Comprehensive diagnosis of axillary sentinel lymph nodes by subcutaneous CEUS via areola combined with VTIQ can improve the diagnostic accuracy of early breast cancer.